Catheter ablation of a small cardiac vein-related right accessory pathway: a case report
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Abstract: A 20-year-old man with Wolff-Parkinson-White syndrome was referred for re-evaluation after a failed attempt to abate the right free-wall accessory pathway(AP). His resting surface electrocardiogram(ECG) suggested a septal AP. The earliest anterograde ventricular activation was documented at the 9-10 o'clock of the tricuspid annulus, and ablation at this site was irresponsible. This earliest retrograde atrial activation was documented at the atrial side during right ventricular pacing. While maneuvering the catheter in this site for further mapping, it was positioned in an orifice with impedance rising from 120 Ω to 250 Ω, and the AP was temporarily blocked. Selected venography by ablation catheter revealed small cardiac veins drained into the atrium by this site. The distance between the orifice and the tricuspid annulus was 1.5 cm. Ablation at the margin of this orifice with 35 W, 43℃ and 30 ml/min saline irrigation speed successfully eliminated the retrograde conduction of the AP within 3 s and continued to 60 s. No periprocedural complications occurred, and ECG showed no evidence of ventricular pre-excitation after ablation. At 6-months follow-up, the patient experienced no tachycardia recurrence.
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[1] Long DY,Dong JZ,Liu XP,et al.Ablation of right-sided accessory pathways with atrial insertion far from the tricuspid annulus using an electroanatomical mapping system[J].J Cardiovasc Electrophysiol,2011,22(5):499-505.
[2] Cendrowska-Pinkosz M.The variability of the small cardiac vein in the adult human heart[J].Folia Morphol(Warsz),2004,63(2):159-162.
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