A simple method to ablate left-sided accessory pathways in a patient with coronary sinus ostial atresia and persistent left superior vena cava: A case report

Introduction Wolff-Parkinson-White (WPW) syndrome is characterized by a short PR interval, wide QRS complex, and paroxysmal supraventricular tachycardia. An accessory atrioventricular connection is known to be the underlying mechanism of this syndrome. Accessory pathways (APs) are mainly located along the tricuspid or mitral annulus, accounting for 10%– 20% and 50%–60% of cases, respectively. Multielectrode recordings from a coronary sinus (CS) catheter facilitate the identification of the location of left free-wall APs; therefore, the usage of CS catheters is currently the standard for ablation of left free-wall APs. Coronary sinus atresia is a rare anomaly and is generally accompanied by venous drainage into (1) a persistent left superior vena cava (PLSVC), (2) the left atrium through an unroofed CS, or (3) the cardiac chambers through collateral venous pathways. This anomaly becomes a problem in procedures such as cardiac resynchronization therapy or catheter ablation of a left-sided AP, which require cannulation of the CS. Herein, we present a rare case of a 43-yearold woman with 2 left-sided APs accompanied by coronary sinus ostial atresia (CSOA) and a PLSVC.