A Case of Manifest WPW Syndrome and Atrioventricular Reentrant Tachycardia Combined with Persistent Left Superior Vena Cava

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A case of 41 years old female: She suffered from palpitation which onset and termination occurred suddenly. She was diagnosed as manifest WPW syndrome and admitted in May 2010 to perform a cardiac electrophysiological study and radiofrequency catheter ablation (RFCA). When we delivered the catheter to coronary sinus (CS), it was deviated largely out of the heart to the cranial direction. A persistent left superior vena cava (PLSVC) and dilated CS were confirmed by CS angiography. A narrow QRS tachycardia was induced by atrial pacing, and it was diagnosed as orthodromic atrioventricular reentrant tachycardia which conducts antegradely with normal conducting system and retrogradely with left posterolateral accessory pathway. Also, reverse common type atrial flutter was induced. RFCA was performed. We mapped mitral annulus retrogradely and successfully ablated the accessory pathway. We also made an electrical blockline at cavotricuspid isthmus and ended the session. She had no palpitation since then. Case reports of WPW syndrome combined with PLSVC are rare. The accessory pathway reported in our case was connected to ventricle and atrium in ordinary pattern, though there is a case report of accessory pathway connected with CS musculature. The relation between PLSVC and accessory pathway is unknown, though it may be possible because there is a report that the developmental timing of atrioventricular annulus and CS is same.
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