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Wolff-Parkinson-White syndrome: where is the pathway?

Turakhia MP, Scheinman M, Badhwar N - Indian Pacing Electrophysiol J (2009)

Bottom Line: The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch.Radiofrequency energy application at this area led to loss of preexcitation.Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

View Article: PubMed Central - PubMed

Affiliation: Electrophysiology Section, Department of Medicine, Stanford University. mintu@stanford.edu

ABSTRACT
A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

No MeSH data available.


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Left anterior oblique fluoroscopic image from electrophysiology study showing the ablator position at the successful site in the coronary sinus. HRA = high right atrial catheterHis = bundle of His catheterAbl = ablation catheter
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Figure 2: Left anterior oblique fluoroscopic image from electrophysiology study showing the ablator position at the successful site in the coronary sinus. HRA = high right atrial catheterHis = bundle of His catheterAbl = ablation catheter

Mentions: Based on these ECG criteria, the coronary sinus and its branches were initially interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch (Figure 2). At this area, an initial early sharp deflection was observed, consistent with a Kent potential (Figure 3).


Wolff-Parkinson-White syndrome: where is the pathway?

Turakhia MP, Scheinman M, Badhwar N - Indian Pacing Electrophysiol J (2009)

Left anterior oblique fluoroscopic image from electrophysiology study showing the ablator position at the successful site in the coronary sinus. HRA = high right atrial catheterHis = bundle of His catheterAbl = ablation catheter
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2655076&req=5

Figure 2: Left anterior oblique fluoroscopic image from electrophysiology study showing the ablator position at the successful site in the coronary sinus. HRA = high right atrial catheterHis = bundle of His catheterAbl = ablation catheter
Mentions: Based on these ECG criteria, the coronary sinus and its branches were initially interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch (Figure 2). At this area, an initial early sharp deflection was observed, consistent with a Kent potential (Figure 3).

Bottom Line: The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch.Radiofrequency energy application at this area led to loss of preexcitation.Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

View Article: PubMed Central - PubMed

Affiliation: Electrophysiology Section, Department of Medicine, Stanford University. mintu@stanford.edu

ABSTRACT
A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

No MeSH data available.


Related in: MedlinePlus