Int J Arrhythm.  2021 Jun;22(2):8. 10.1186/s42444-021-00037-9.

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

• Paymard M
• Deyell M
• Chakrabarti S
• Laksman Z
• Larsen J
• Yeung‑Lai‑Wah J

• KMID: 2517279
• DOI: http://doi.org/10.1186/s42444-021-00037-9

Abstract

Background
This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal acces‑ sory 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 diverticu‑ lum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroana‑ tomic 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.

Keyword

Coronary sinus diverticulum; Posteroseptal accessory pathway; Supraventricular tachycardia; Wolff– Parkinson–White syndrome; Three-dimensional cardiac mapping; Catheter ablation