Successful Radiofrequency Catheter Ablation of Left Anterolateral Accessory Pathway Associated with a Coronary Sinus Diverticulum Using an Irrigated-Tip Catheter

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Background: Left posterior-posteroseptal accessory pathways associated with the coronary sinus diverticulum have been reported. We report a rare case of a manifest left anterolateral accessory pathway associated with a coronary sinus diverticulum. Case: Twelve years-old boy, his 12-leads ECG revealed sinus rhythm with positive delta waves in leads II, III, and aVf, was suffering from recurrent supraventricular tachycardia. At the first admission, he had undergone the catheter ablation of left anterolateral region of the mitral annulus via the femoral artery. The Delta waves disappeared but tachycardia was easily induced. During tachycardia, the ventriculoatrial conduction time was not so short around there. Coronary sinus venography revealed the divericulum near its ostium. An additional ablation was performed near the neck of the diverticulum, revealing the shortest ventriculoatrial conduction time, via the femoral artery. However, the tachycardia re-occurred one month later. At the second admission, ventriculoatrial conduction during ventricular pacing was mapped meticulously using Ensite NavX system. The pathway where the shortest ventriculoatrial conduction time and accessory pathway potential were recorded at the neck of coronary sinus diverticulum was successfully ablated using an irrigated-tip catheter via the femoral vein.