Refractory supraventricular tachycardia from a coronary sinus diverticulum leading to cardiogenic shock: a challenging ablation case

A 58-year-old male with a past medical history of radiofrequency ablation of a concealed posteroseptal accessory pathway presented to the emergency department with palpitations and acute heart failure. The electrocardiogram showed narrow QRS tachycardia with a heart rate of 170 bpm. Despite boluses of adenosine and amiodarone perfusion, the patient experienced recurrent supraventricular tachycardia (SVT), leading to cardiogenic shock. Extracorporeal membrane oxygenation was initiated for hemodynamic support. Electrophysiologic study identified an accessory pathway in a coronary sinus diverticulum. Successful radiofrequency ablation was performed, resulting in clinical and left ventricular ejection fraction improvement. This case highlights the challenges in managing incessant SVT with cardiogenic shock and complex ablation procedures.