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. 2016 Feb 23;13(5):158-161.
doi: 10.1016/j.jccase.2016.01.007. eCollection 2016 May.

Catheter ablation for Wolff-Parkinson-White syndrome with coronary sinus diverticulum in a 15-year-old boy

Shuhei Fujita  1 , Kazuo Usuda  2 , Kiyoshi Hatasaki  1
Affiliations

Catheter ablation for Wolff-Parkinson-White syndrome with coronary sinus diverticulum in a 15-year-old boy

Shuhei Fujita et al. J Cardiol Cases. .

Abstract

The left posterior and posteroseptal accessory pathways often have an epicardial accessory and are associated with coronary vein anomalies, such as diverticulum, fusiform, or bulbous enlargement. We report the case of a 15-year-old boy who suffered from palpitation due to Wolff-Parkinson-White syndrome with coronary sinus diverticulum. An electrophysiology study revealed a left posterior accessory pathway and orthodromic atrioventricular reciprocating tachycardia. After the transseptal puncture, we performed mapping around the mitral annulus during sinus rhythm. We could not detect typical atrioventricular fusion accompanied with accessory pathway potential and failed to ablate around the mitral annulus. We revealed typical accessory pathway potential in a coronary vein and successfully ablated. After ablation, a right atrium angiography showed a successful ablation site was just at the neck of coronary sinus diverticulum. It is important for a successful and safe ablation to evaluate coronary vein anomalies in patients with left posterior and posteroseptal accessory pathways. <Learning objective: In pediatric patients, Wolff-Parkinson-White syndrome with the posteroseptal accessory pathway with coronary sinus diverticulum is rare. It is important to predict the left posterior and posteroseptal accessory pathways from the polarity of the delta wave; ablation for pediatric patients seems to be more effective and safe in confirming coronary sinus diverticulum by echocardiogram before electrophysiology study and performing coronary vein angiography before mapping of the accessory pathway.>.

Keywords: Coronary sinus diverticulum; Radiofrequency catheter ablation; Wolff–Parkinson–White syndrome.

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Figures

Fig. 1
Fig. 1
Twelve-lead electrocardiogram (ECG) before and after radiofrequency catheter ablation. (a) ECG showing V1 isoelectric and II, III, aVF negative delta wave, especially III, aVF showed steep negative delta wave. (b) Normal PQ interval and no delta wave.
Fig. 2
Fig. 2
Successful ablation site, 12-lead electrocardiogram (ECG) and intracardiac ECG of induced supraventricular tachycardia (SVT). (a) 12-lead ECG of induced SVT (b) Intracardiac ECG of induced SVT showed retrograde earliest atrial activation site at CS5-6. (c) Intracardiac electrogram showed typical AV fusion accompanied with accessory pathway potential at ABL. (d) Delta wave was interrupted for 2.4 s with a radiofrequency pulse (RF on). (e) Right and left anterior oblique right atrium angiography. Arrow denotes the coronary sinus diverticulum. The position of ablation catheter is at the site of successful ablation. ABL, ablation catheter; CS, CS electrode; His, His bundle electrode; RVA, RVA electrode.
Fig. 2
Fig. 2
Successful ablation site, 12-lead electrocardiogram (ECG) and intracardiac ECG of induced supraventricular tachycardia (SVT). (a) 12-lead ECG of induced SVT (b) Intracardiac ECG of induced SVT showed retrograde earliest atrial activation site at CS5-6. (c) Intracardiac electrogram showed typical AV fusion accompanied with accessory pathway potential at ABL. (d) Delta wave was interrupted for 2.4 s with a radiofrequency pulse (RF on). (e) Right and left anterior oblique right atrium angiography. Arrow denotes the coronary sinus diverticulum. The position of ablation catheter is at the site of successful ablation. ABL, ablation catheter; CS, CS electrode; His, His bundle electrode; RVA, RVA electrode.
Fig. 3
Fig. 3
Transthoracic echocardiogram and 3-dimensional computed tomography of coronary sinus diverticulum. (a) Long axis, (b) short axis, and (c) posteroinferior view. Arrow denotes the coronary sinus diverticulum.
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