A small but definite percentage of left sided (5%) accessory pathways (AP) may be difficult to ablate with the conventional endocardial approach (subepicardial course, particular anatomic configurations of the coronary sinus). In these circumstances an RF ablation from within the coronary sinus (RF CS) could be accomplished. We describe our technique of CS RF ablation and comment on some aspects derived from our experience. The study group comprise four pts (2 f, 2 m; mean age 41.5), with symptomatic tachyarrhythmias (SVT) associated with left sided APS (3 manifest, 1 concealed, in whom a previous RF endocardial approach had proven to be unsuccessful. After conventional mapping and coronary arteriography (to detail left circumflex artery and to obtain levophase CS angiograms) the ablation catheter introduced from the femoral vein was positioned in the CS alongside with the mapping catheter previously introduced from the subclavian vein. A coronary catheter was left in left coronary orifice in order to continuously update angiographic data. A presumed AP activation potential with unique characteristics was recorded in the CS in 4/4 pts: large, sharp, greater than the local atrial and ventricular components of the electrogram. All APs were ablated with a median of four applications (range one to ten), mean energy was 24 W from 10s (in all pts the 'successful' impulse interrupted conduction in less than 2 s). No damage was evident in the circumflex artery, a probable small thrombus in the site of ablation was present in 2/4. In the follow up (3-19 months) AP conduction remained abolished in 3/4 and resumed retrograde only conduction in 1 (without SVT inducibility). There were no recurrences of SVT and no complications. With accurate mapping (recording of specific AP potential) and great caution (angiographic visualization of left circumflex artery and CS) RF CS ablation in selected cases seems to be feasible, highly effective and relatively safe.
|Number of pages||6|
|Journal||New Trends in Arrhythmias|
|Publication status||Published - 1993|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine