Korean Circ J.  2009 Sep;39(9):389-391. 10.4070/kcj.2009.39.9.389.

Successful Radiofrequency Catheter Ablation for Wolff-Parkinson-White Syndrome Within the Neck of a Coronary Sinus Diverticulum

• Jang SW
• Rho TH
• Kim DB
• Kwon BJ
• Cho EJ
• Shin WS
• Kim JH
• Jin SW
• Oh YS
• Lee MY
• Kim JH

• KMID: 2225677
• DOI: http://doi.org/10.4070/kcj.2009.39.9.389

Abstract

Posteroseptal accessory pathways are often associated with coronary sinus diverticula. These diverticula contain myocardial coats which serve as a bypass tract. We report a 54-year-old woman who underwent radiofrequency (RF) catheter ablation for Wolff-Parkinson-White (WPW) syndrome. The surface electrocardiography (ECG) demonstrated pre-excitation, indicating a posteroseptal accessory pathway. A catheter ablation via a transaortic approach failed to ablate the accessory pathway. Coronary sinus venography revealed the presence of a diverticulum near the ostium. An electrogram in the neck of the diverticulum showed the coronary sinus myocardial extension potential, which was successfully ablated by delivery of RF energy.

Keyword

Wolff-Parkinson-white syndrome; Coronary sinus; Diverticulum; Radiofrequency catheter ablation

MeSH Terms

Catheter Ablation
Coronary Sinus
Diverticulum
Electrocardiography
Female
Humans
Middle Aged
Neck
Phlebography
Wolff-Parkinson-White Syndrome

Figure

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  Fig. 1 Surface ECG showing pre-excitation. ECG: electrocardiography.

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  Fig. 2 Coronary sinus venography showing a diverticulum with a narrow neck (arrows) near the ostium.

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  Fig. 3 Surface ECG and electrogram recordings during ventricular pacing. A: early retrograde sharp atrial potential representing coronary sinus activity (arrow). B: electrograms during ablation showing disconnection of the accessory pathway. ECG: electrocardiography, HRA: high right atrium, ABL: ablation, CS: coronary sinus, RVA: right ventricular apex, Stim: stimulation.

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