Refractory supraventricular tachycardia from a coronary sinus diverticulum leading to cardiogenic shock: a challenging ablation case
Abstract
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. An 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.
References
- Shinbane JS, Wood MA, Jensen DN et al. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 1997;29:709-15. DOI: https://doi.org/10.1016/S0735-1097(96)00592-X
- Shoureshi P, Tan AY, Koneru J, et al. Arrhythmia-induced cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol 2024;83:2214-32. DOI: https://doi.org/10.1016/j.jacc.2024.03.416
- Sanhueza S, Vergara I, Bittner A, et al. Cardiogenic shock due to arrhythmia-induced cardiomyopathy and its recovery after radiofrequency ablation under extracorporeal membrane oxygenation support. Heart Rhythm O2 2022;3:874-8. DOI: https://doi.org/10.1016/j.hroo.2022.10.006
- Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology: Developed in collaboration with the Association for European Paediatric and Congenital Cardiology. Eur Heart J 2020;41:655-720 DOI: https://doi.org/10.1093/eurheartj/ehz467
- Mantini N, Zipse M, Tompkins C, et al. Ablation of atrial arrhythmias in patients with cardiogenic shock on mechanical circulatory support. HeartRhythm Case Rep 2018;5:115-9. DOI: https://doi.org/10.1016/j.hrcr.2018.11.008
- Leitz P, Wasmer K, Kobe J, et al. Remaining challenges in catheter ablation of accessory pathways: rare entity of coronary sinus diverticulum-associated pathways. Clin Res Cardiol 2019;108:388-94. DOI: https://doi.org/10.1007/s00392-018-1367-3
- Zhang S, Wu Z, Chen M, et al. Comparison conventional approach and three-dimensional mapping system in the catheter ablation of accessory pathway associated with coronary sinus diverticulum: a single-center experience. Ann Noninvasive Electrocardiol 2024;29:e13100. DOI: https://doi.org/10.1111/anec.13100
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