Retrograde fast pathway cryoablation inside the coronary sinus for slow-fast atrioventricular nodal reentrant tachycardia in a patient with persistent left superior vena cava

J Cardiovasc Electrophysiol. 2023 Feb;34(2):478-482. doi: 10.1111/jce.15795. Epub 2023 Jan 5.

Abstract

Introduction: Persistent left superior vena cava (PLSVC) is accompanied by enlarged coronary sinus (CS) and deformation of the triangle of Koch. This makes anatomical evaluation of the atrioventricular (AV) nodal pathways difficult.

Methods: We attempted cryoablation of retrograde fast pathway located in the enlarged CS roof of PLSVC for slow-fast AV nodal reentrant tachycardia (AVNRT) induced by inadvertent antegrade fast pathway elimination during ablation of left atrial tachycardia.

Results: Slow-fast AVNRT was successfully eliminated without AV block progression.

Conclusions: This is the first case of successful retrograde fast pathway ablation of the CS ostial roof for slow-fast AVNRT with PLSVC.

Keywords: coronary sinus; fast pathway; persistent left superior vena cava; slow pathway; slow-fast atrioventricular nodal reentrant tachycardia.

Publication types

  • Case Reports

MeSH terms

  • Catheter Ablation*
  • Coronary Sinus* / diagnostic imaging
  • Coronary Sinus* / surgery
  • Cryosurgery*
  • Humans
  • Persistent Left Superior Vena Cava*
  • Tachycardia, Atrioventricular Nodal Reentry* / diagnosis
  • Tachycardia, Atrioventricular Nodal Reentry* / surgery
  • Vena Cava, Superior / diagnostic imaging
  • Vena Cava, Superior / surgery