scholarly journals Cryoablation of a Mahaim Epicardial Accessory Pathway Inside Coronary Sinus Using an 8-mm Catheter

2021 ◽  
pp. 79-83
Author(s):  
Bruno Pereira Valdigem ◽  
Nilton José Carneiro da Silva ◽  
Rogerio Braga Andalaft ◽  
Carla Almeida ◽  
Nilson Araujo Junior ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Sinus ◽  
Accessory Pathway ◽  
Review Literature ◽  
Atrial Fibrillation Ablation ◽  
Low Flow ◽  
White Syndrome ◽  
Ablation Technique ◽  
Wolff Parkinson White Syndrome

Cyoablation is a ablation technique underutilized except in parahissian pathways and atrial fibrillation ablation. Ablation inside venous coronary sinus remains a dreaded incursion, and cryoablation is rarely used. We present the case of a 43 YO female who had a recurrent wolff parkinson white syndrome due to an epicardial pathway inside the coronary sinus successfully treated with a large bore(8mm) cryocatheter. We also review literature and describe the advantages and similar reports of use of cryo in low flow recesses inside the heart.

scholarly journals Use of 3D mapping system for ablating an accessory pathway associated with coronary sinus diverticulum

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohammad Paymard ◽  
Marc W. Deyell ◽  
Santabhanu Chakrabarti ◽  
Zachary W. Laksman ◽  
Jacob Larsen ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Accessory Pathway ◽  
Three Dimensional ◽  
Radiofrequency Energy ◽  
Cardiac Mapping ◽  
Unsuccessful Attempt ◽  
White Syndrome ◽  
Mapping System ◽  
Coronary Sinus Diverticulum ◽  
Wolff Parkinson White Syndrome

Abstract Background This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal accessory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries. Case Presentation The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticulum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroanatomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. Conclusion We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.

scholarly journals Old stuff still trending. Use of propafenone as a safety net until catheter ablation in a patient with documented pre-excited atrial fibrillation and Wolff-Parkinson-White syndrome—a classic case report

2021 ◽  
Author(s):  
Dimitrios Karelas ◽  
John Papanikolaou ◽  
Charalampos Kossyvakis ◽  
Dimitrios Platogiannis
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Sinus Rhythm ◽  
Cardiac Death ◽  
Accessory Pathway ◽  
Safety Net ◽  
White Syndrome ◽  
Rr Interval ◽  
Wolff Parkinson White Syndrome

Abstract Background Atrial Fibrillation in Wolff-Parkinson-White syndrome may result in life-threateningly rapid antegrade conduction over a bypass tract, manifested by an irregular broad-complex (pre-excited) tachycardia that can degenerate to ventricular fibrillation. Shortest pre-excited RR interval below 250msec during atrial fibrillation predicts increased risk of sudden cardiac death. Case summary We report a case of a 43-year-old man with unremarkable cardiac history who presented due to sudden-onset feeling of palpitations and pre-syncope after strenuous lifting. Electrocardiography depicted fast pre-excited atrial fibrillation. The shortest pre-excited RR interval was estimated at 160msec, indicating an accessory pathway with short antegrade refractory period at risk for mediating sudden cardiac death. Direct current cardioversion restored sinus rhythm unraveling delta-waves. The patient was put on propafenone 450 mg/day having an uneventful clinical course. On day-10 post-admission, electrophysiological study induced rapid atrial fibrillation but the shortest pre-excited RR interval was substantially increased to 264msec. A left anterolateral accessory pathway was ablated. The patient remained symptom-free until his latest follow-up in the third month post-ablation without manifest pre-excitation on surface electrocardiogram. Discussion Treatment options of pre-excited atrial fibrillation include anti-arrhythmic agents but mainly electrical cardioversion. Cardioversion can safely restore sinus rhythm, while use of anti-arrhythmics often requires ICU monitoring due to risk of QT prolongation. Catheter ablation is the mainstay of therapy for symptomatic patients. Our rare report highlights the direct impact of propafenone on prolonging the refractoriness of the accessory pathway, effectively and safely, and reappraises propafenone’s worthiness as a protective measure following pre-excited atrial fibrillation episode until ablation.

A 2-year-old child with coronary sinus diverticulum and Wolff–Parkinson–White syndrome

2012 ◽  
Vol 23 (2) ◽  
pp. 274-276 ◽  
Author(s):  
Haridas P. Veloor ◽  
Yash Lokhandwala
Keyword(s):  
Radiofrequency Ablation ◽  
Coronary Sinus ◽  
Accessory Pathway ◽  
White Syndrome ◽  
Electrophysiological Analysis ◽  
Coronary Sinus Diverticulum ◽  
Wolff Parkinson White Syndrome

AbstractA 2-year-old child having Wolff–Parkinson–White syndrome presented with recurrent drug-refractory tachycardia episodes. On electrophysiological analysis, a coronary sinus diverticulum was discovered. The accessory pathway was successfully eliminated by radiofrequency ablation within the diverticulum.

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