Author + information
- Received December 1, 2016
- Revision received December 19, 2016
- Accepted December 22, 2016
- Published online June 19, 2017.
- Kazuaki Nakajima, MD,
- Taishi Fujisawa, MD,
- Shin Kashimura, MD,
- Akira Kunitomi, MD,
- Yoshinori Katsumata, MD,
- Takahiko Nishiyama, MD,
- Takehiro Kimura, MD,
- Nobuhiro Nishiyama, MD,
- Yoshiyasu Aizawa, MD and
- Seiji Takatsuki, MD∗ ()
- ↵∗Address for correspondence:
Dr. Seiji Takatsuki, Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan.
A 50-year-old man with a history of undergoing catheter ablation twice, 10 and 7 years ago, for persistent atrial fibrillation (AF) underwent the third catheter ablation for paroxysmal AF that recurred 3 years ago. He had no history of cardiac surgery. Coronary sinus (CS) ostial atresia was pointed out during the first ablation procedure before radiofrequency application by failing to place the CS catheter and performing coronary angiography. The cardiac computed tomography revealed CS atresia with a small cardiac vein and a persistent left superior vena cava (PLSVC) (Figures 1A and 1B) as venous drainages.
During the third procedure, the electrical isolation of pulmonary veins was confirmed. Then PLSVC was targeted where it was known as a possible pathogenesis of AF (1). PLSVC was too narrow to approach via the innominate vein. Hence, we attempted to puncture the closed CS ostium by a radiofrequency transseptal needle under the guidance of intracardiac echocardiography and CS venography, a follow-through of the left coronary angiography. CS was successfully punctured and a direct CS venography was taken via SL2 long sheath (Figures 1C and 1D). Initiation of the AF from the PLSVC was recorded using a ring catheter placed in the PLSVC (Figure 2), which was successfully isolated without complications.
Successful electrical isolation of the “no entry” PLSVC was obtained in a patient of AF with a CS ostial atresia by passing an ablation catheter through the closed CS ostium punctured by a transseptal needle.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- Received December 1, 2016.
- Revision received December 19, 2016.
- Accepted December 22, 2016.
- 2017 American College of Cardiology Foundation