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Wolff-Parkinson-White Syndrome and Atrial Fibrillation in a Patient With a Coronary Sinus Diverticulum

2007; Lippincott Williams & Wilkins; Volume: 115; Issue: 20 Linguagem: Inglês

10.1161/circulationaha.106.676866

1524-4539

Robert Blank, Thomas Dieterle, Stefan Osswald, Christian Sticherling,

Cardiac pacing and defibrillation studies

HomeCirculationVol. 115, No. 20Wolff-Parkinson-White Syndrome and Atrial Fibrillation in a Patient With a Coronary Sinus Diverticulum Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBWolff-Parkinson-White Syndrome and Atrial Fibrillation in a Patient With a Coronary Sinus Diverticulum Robert Blank, MD, Thomas Dieterle, MD, Stefan Osswald, MD and Christian Sticherling, MD Robert BlankRobert Blank From the Division of Cardiology, University Hospital of Basel, Switzerland. , Thomas DieterleThomas Dieterle From the Division of Cardiology, University Hospital of Basel, Switzerland. , Stefan OsswaldStefan Osswald From the Division of Cardiology, University Hospital of Basel, Switzerland. and Christian SticherlingChristian Sticherling From the Division of Cardiology, University Hospital of Basel, Switzerland. Originally published22 May 2007https://doi.org/10.1161/CIRCULATIONAHA.106.676866Circulation. 2007;115:e469–e471A 51-year-old woman without known cardiac disease presented with an irregular wide QRS-complex tachycardia (Figure 1). After electrical cardioversion, the 12-lead surface ECG revealed sinus rhythm with ventricular preexcitation and negative delta waves in leads II, III, and aVF, indicating Wolff-Parkinson-White syndrome with a posteroseptal accessory pathway (Figure 2). The distinctly negative delta wave in lead II pointed to an accessory pathway within a coronary sinus diverticulum. This finding was confirmed by contrast media injection into the coronary sinus (Figure 3). In the electrophysiological study, orthodrome atrioventricular-reentrant tachycardia was easily inducible, and the earliest ventricular activation during sinus rhythm was mapped and found to be within the coronary sinus diverticulum. Using an irrigated-tip radiofrequency catheter, the accessory pathway was easily ablated at the neck of the diverticulum. Accessory pathways in this location tend to have a very rapid atrioventricular conduction, putting these patients at risk of sudden death during atrial fibrillation; such pathways, therefore, should be ablated.1Download figureDownload PowerPointFigure 1. Twelve-lead surface ECG (25 mm/s) of an irregular wide QRS-complex tachycardia during atrial fibrillation in the presence of a rapidly conducting accessory pathway.Download figureDownload PowerPointFigure 2. Twelve-lead surface ECG (25 mm/s): sinus rhythm with ventricular preexcitation and negative delta waves in leads II, III, and aVF.Download figureDownload PowerPointFigure 3. Giant coronary sinus diverticulum (contrast media injection; 45-degree left anterior oblique view).DisclosuresNone.FootnotesCorrespondence to Christian Sticherling, MD, Division of Cardiology, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland. E-mail: [email protected]Reference1 Binder TM, Rosenhek R, Frank H, Gwechenberger M, Maurer G, Baumgartner H. Congenital malformations of the right atrium and the coronary sinus. Chest. 2000; 117: 1740–1748.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Razeghian‐Jahromi I, Natale A and Nikoo M (2020) Coronary sinus diverticulum: Importance, function, and treatment, Pacing and Clinical Electrophysiology, 10.1111/pace.14026, 43:12, (1582-1587), Online publication date: 1-Dec-2020. Fujita S, Usuda K and Hatasaki K (2016) Catheter ablation for Wolff–Parkinson–White syndrome with coronary sinus diverticulum in a 15-year-old boy, Journal of Cardiology Cases, 10.1016/j.jccase.2016.01.007, 13:5, (158-161), Online publication date: 1-May-2016. WU X, ZHU R, JIANG H and LIU W (2013)(2013) Supraventricular tachycardia and atrial flutter associated with a coronary sinus diverticulum: A case report, Experimental and Therapeutic Medicine, 10.3892/etm.2013.1050, 5:6, (1752-1754), Online publication date: 1-Jun-2013. AVARI J and RHEE E (2008) Markers of Coronary Sinus Accessory Pathways in Pediatrics, Pacing and Clinical Electrophysiology, 10.1111/j.1540-8159.2008.01123.x, 31:8, (968-973), Online publication date: 1-Aug-2008. THAL S, THAI H, JUNEMAN E and GOLDMAN S (2008) Coronary Sinus Diverticulum Complicating CRT Device Implantation, Pacing and Clinical Electrophysiology, 10.1111/j.1540-8159.2008.01160.x, 31:9, (1184-1185), Online publication date: 1-Sep-2008. May 22, 2007Vol 115, Issue 20 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.676866PMID: 17515469 Originally publishedMay 22, 2007 PDF download Advertisement SubjectsArrhythmiasCatheter Ablation and Implantable Cardioverter-Defibrillator