A simple method to ablate left-sided accessory pathways in a patient with coronary sinus ostial atresia and persistent left superior vena cava: A case.

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A simple method to ablate left-sided accessory pathways in a patient with coronary sinus ostial atresia and persistent left superior vena cava: A case report Shohei Kataoka, MD, Kenji Enta, MD, PhD, Kyoichiro Yazaki, MD, Mitsuru Kahata, MD, Yasuhiro Ishii, MD, PhD HeartRhythm Case Reports Volume 3, Issue 1, Pages 93-96 (January 2017) DOI: 10.1016/j.hrcr.2016.09.014 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 On the venous phase of the coronary angiography, there was no coronary sinus ostium and venous drainage into a persistent left-sided superior vena cava existed. A: Anterior-posterior (AP) view. B: Left anterior oblique (LAO) view. (A: yellow arrows= PLSVC) (B: yellow arrowheads = PLSVC) HeartRhythm Case Reports 2017 3, 93-96DOI: (10.1016/j.hrcr.2016.09.014) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 The direct cannulation of the multielectrode catheter from the left jugular vein to a persistent left-sided superior vena cava is shown. A: Anterior-posterior (AP) view. B: Left anterior oblique (LAO) view. HeartRhythm Case Reports 2017 3, 93-96DOI: (10.1016/j.hrcr.2016.09.014) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 A: Although the earliest retrograde atrial activations were recorded in the coronary sinus (CS) 3–4 region, the successful ablation site of the first accessory pathway was on the slightly proximal side of the CS catheter (ie, opposite the site of the blind end of the CS) from the earliest retrograde atrial activation recorded region, and on the slightly ventricular sides of the CS catheter positioned in the persistent left superior vena cava (PLSVC). Using radiofrequency (RF) energy delivered to this site, ventriculoatrial (VA) conduction disappeared, but the retrograde atrial activation emerged again and changed to the CS13–14 region. B: Although the earliest retrograde atrial activations were recorded in the CS13–14 region, the successful ablation site of the second accessory pathway was on the slightly proximal side of the CS catheter (ie, opposite the site of the blind end of the CS) from the earliest retrograde atrial activation recorded region, and on the slightly ventricular sides of the CS catheter positioned in the PLSVC. After the delivery of the RF energy to this new site, only VA conduction through the atrioventricular node remained. LAO = left anterior oblique; RAO = right anterior oblique. HeartRhythm Case Reports 2017 3, 93-96DOI: (10.1016/j.hrcr.2016.09.014) Copyright © 2016 Heart Rhythm Society Terms and Conditions