European heart journal. Case reports · 2026
Epicardial left lateral accessory pathways: an uncommon cause of ablation failure-insights from a case series.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Charitos Dimitrios, Sousonis Vasileios, Asvestas Dimitrios, Vavouris Emmanouil, Karanikas Stavros, Vardas Emmanouil P, Tzeis Stylianos
Аннотация
BACKGROUND: Catheter ablation is the treatment of choice for patients with recurrent, symptomatic accessory pathway (AP)-related tachycardias and for asymptomatic patients with high-risk pathways. Catheter ablation is associated with high success rates and low risk of complications, particularly when the pathway is located at the mitral annulus. Epicardial left lateral APs are rare but can account for ablation failures, posing a significant therapeutic challenge.
CASE SUMMARY: We report two young patients with recurrent paroxysmal supraventricular tachycardias related to a left lateral AP. In both cases, endocardial ablation targeting the lateral mitral annulus failed. Subsequent mapping of the coronary sinus and its branches revealed earliest activation sites consistent with an epicardial course of the APs. Subsequent deployment of radiofrequency energy lesions within the coronary venous system using an irrigated-tip catheter resulted in immediate and durable AP elimination.
DISCUSSION: Epicardial left lateral APs are an uncommon but important cause of failed ablation. Ablation within the coronary venous system, particularly when guided by three-dimensional electroanatomic mapping and performed with irrigated-tip catheters, can be both effective and safe. However, meticulous mapping and targeted energy delivery are necessary to prevent potential complications, such as venous stenosis, thrombosis vascular injury, and perforation.
CASE SUMMARY: We report two young patients with recurrent paroxysmal supraventricular tachycardias related to a left lateral AP. In both cases, endocardial ablation targeting the lateral mitral annulus failed. Subsequent mapping of the coronary sinus and its branches revealed earliest activation sites consistent with an epicardial course of the APs. Subsequent deployment of radiofrequency energy lesions within the coronary venous system using an irrigated-tip catheter resulted in immediate and durable AP elimination.
DISCUSSION: Epicardial left lateral APs are an uncommon but important cause of failed ablation. Ablation within the coronary venous system, particularly when guided by three-dimensional electroanatomic mapping and performed with irrigated-tip catheters, can be both effective and safe. However, meticulous mapping and targeted energy delivery are necessary to prevent potential complications, such as venous stenosis, thrombosis vascular injury, and perforation.