Radiofrequency ablation of a middle cardiac vein inserted accessory pathway resulting in posterolateral coronary artery occlusion: A case report
| Autor: | Marina Vieira Nagahama, Angelo Amato Vincenzo de Paola, Saulo Rodrigo Ramalho de Moraes, José Nunes de Alencar Neto, Claudio Cirenza, Rafael Thiesen Magliari |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system Radiofrequency ablation medicine.medical_treatment Middle Cardiac Vein Case Report Catheter ablation Coronary sinus Accessory pathway 030204 cardiovascular system & hematology Chest pain law.invention 03 medical and health sciences 0302 clinical medicine law Physiology (medical) medicine.artery Internal medicine medicine 030212 general & internal medicine Posterolateral Coronary Artery business.industry Wolff-Parkinson-White syndrome Coronary artery stenosis Epicardium Middle cardiac vein lcsh:RC666-701 Right coronary artery Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Indian Pacing and Electrophysiology Journal, Vol 19, Iss 1, Pp 34-38 (2019) Indian Pacing and Electrophysiology Journal |
| ISSN: | 0972-6292 |
| Popis: | Introduction: Posteroseptal accessory pathways account for 34.5% of the total. Of these, 36% are located within the coronary sinus (CS). Its ablation requires technical alternatives to avoid damage to surrounding tissues, especially branches of the right coronary artery. Case report: A 22-year-old man was referred for re-do ablation of an accessory left septal-septal (PSE) pathway. Inside the CS, a precocity of 25 ms was found in the region of the median cardiac vein (VCM) (Fig. 2, panel A). Radiofrequency (RF) was administered with a non-irrigated bidirectional catheter within this vessel with resolution of the pre-excitation after 5 seconds. Immediately after, the patient presented chest pain and revealed a ST segment elevation of 1 mm in the inferior leads of ECG. Coronary angiography showed occlusion of the middle third of the posterior ventricular branch of the right coronary artery, with no signs of thrombus or dissection. Arterial angioplasty was performed with a bare metal stent, followed by TIMI III distal flow. Retrograde aortic mapping was performed and a precocity of 20 ms was found in the PSE region. The RF was applied followed by loss of pre-excitation after 1.5 seconds of application. Conclusion: This case demonstrates the risks involving delivering radiofrequency within the coronary sinus. We discuss some strategy that could help electrophysiologists in similar cases. Keywords: Catheter ablation, Accessory pathway, Epicardium, Coronary sinus, Middle cardiac vein, Wolff-Parkinson-White syndrome, Coronary artery stenosis |
| Databáze: | OpenAIRE |
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