Research Article|Articles in Press

Catheter Ablation of Coronary Sinus Accessory Pathways in the Young



      Accessory atrioventricular pathways (AP) are the most common tachycardia substrate for supraventricular tachycardia (SVT) in the young. Endocardial catheter ablation of AP may be unsuccessful in up to 5% due to a coronary sinus location.


      Data on ablation of accessory pathways within the coronary venous system (CVS) in the young is sparse.


      Analysis of feasibility, outcome, and safety in patients ≤18 years with coronary sinus accessory pathways (CS-AP) and catheter ablation via CVS in a tertiary pediatric electrophysiological referral center (05/2003-12/2021). Control group adjusted for age, weight, and pathway location was established from patients of the prospective European Multicenter Pediatric Ablation Registry who all had endocardial AP ablation.


      24 individuals had mapping and intended AP ablation within the CVS (age: 2.7–17.3 years, body weight: 15.0–72.0 kg). Due to proximity to coronary artery, ablation was withheld in 2/24. Overall procedural success was achieved in 20/22 (90.9%) study patients and in 46/48 (95.8%) controls. Coronary artery injury after RF ablation was noted in 2/22 (9%) study patients and in 1/48 (2%) controls. In CVS patients repeat SVT occurred in 5/22 (23%) during a median follow-up of 8.5 years, 4/5 underwent reablation resulting in 94.4% overall success. Controls were free from SVT during follow-up of 12 months as defined by registry protocol.


      Success of CS-AP ablation in the young was comparable to endocardial AP-ablation. Substantial risk of coronary artery injury should be considered when CS-AP ablation is performed in the young.

      Key Words


      ABL (Ablation catheter), APAccessory Atrioventricular Pathway (Atrioventricular node), AVRT (Atrioventricular Reentrant Tachycardia), b.w. (Body weight), CHD (Congenital Heart Defect), CA (Coronary Artery), CS (Coronary Sinus), CVS (Coronary Venous System), CS-AP (Coronary Sinus Accessory Pathways), Cryo (Cryoenergy application), EP (Electrophysiological), EPS (Electrophysiological Study), EUROPA (European Multicenter Pediatric Ablation Registry), FU (Follow up), F (French), GVA (Great Cardiac Vein), LAO (Left Anterior Oblique), LCX (Left Circumflex Branch), LCA (Left Coronary Artery), MRI (Magnetic Resonance Imaging), MCV (Middle Cardiac Vein), min (Minute), MV (Mitral Valve), n.a. (Not available), PJRT (Permanent Junctional Reciprocating Tachycardia), RF (Radiofrequency), RAO (Right Anterior Oblique), RCA (Right Coronary Artery), RVOT (Right Ventricular Outflow Tract), SVT (Supraventricular Tachycardia), TV (Tricuspid Valve)
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      Linked Article

      • Ablation Within the Coronary Venous System in Young Patients: A Focus on Safety
        Heart Rhythm
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          Despite decades of experience, catheter ablation of an accessory atrioventricular pathway (AP) in the posteroseptal region can still be challenging owing to complex anatomy and the proximity to coronary arteries. This is especially true for APs involving the musculature around the proximal coronary sinus (CS), the middle cardiac vein, or a diverticulum off the CS [1]. The coronary venous system (CVS) can be navigated with high precision guided by a contrast injection in the CS, and the mapping data tend to be relatively unambiguous within these structures, usually displaying a clear AP potential.
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