Catheter ablation of manifest accessory pathways related to the coronary sinus

R. Cappato, C. Weiss, E. Braun, J. Siebels, M. Schluter, K. H. Kuck

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Abstract

Failures by RF current to ablate left-sided APs from an endocardial approach are reported in a minority of cases. Recognition of such 'epicardial' APs is important since in most cases it allows for their ablation by RF current delivered from within the coronary sinus. This study reports on 25 manifest APs related to the CS anatomy. Five APs were ablated at the neck of a CS or MCV diverticulum, and 2 APs were associated with a persistent superior vena cava; of the remaining APs, 8 were ablated in the L PS CS, 9 in the MCV, and 2 in the deep CS. Low energy applications delivered from within the CS resulted in no early or late complications in any patient. Surface ECG delta wave polarity did not help to predict a specific location of epicardial APs in the posteroseptal space (L PS vs MCV), nor the presence of a CS or MCV diverticulum. Local electrogram analysis showed that AP potential relative to atrial potential amplitude is significantly higher in APs related to the MCV than in those located in the LPS region or at the neck of a CS or MCV diverticulum. In addition, successful pulses of MCV APs appear to be more easily achieved when delivered at the distal vessel.

Original languageEnglish
Pages (from-to)421-427
Number of pages7
JournalNew Trends in Arrhythmias
Volume9
Issue number3
Publication statusPublished - 1993

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cappato, R., Weiss, C., Braun, E., Siebels, J., Schluter, M., & Kuck, K. H. (1993). Catheter ablation of manifest accessory pathways related to the coronary sinus. New Trends in Arrhythmias, 9(3), 421-427.