Pathological Findings of Cavotricuspid Isthmus Tissue Eighteen Days after Radiofrequency Catheter Ablation for Typical Atrial Flutter

A 75-year-old man with a prior myocardial infarction, who underwent a coronary artery bypass graft, suffered from typical atrial flutter. He underwent a cavotricuspid linear catheter ablation. Eighteen days after the ablation, he suddenly died. A transmural ablation line was created between the inferior vena cava and tricuspid annulus. Transmural loss of the cardiomyocytes and small clusters of coagulative necrosis were observed. Evidence of edema and a patchy hemorrage remained in the extracellular space

Stent placement to stabilize the left ventricular lead in the coronary sinus

Recently, cardiac resynchronization therapy (CRT. has been established as an effective treatment for drug-resistant heart failure with left ventricular dyssynchrony in patients with a New York Heart Association class (NYHA. of III-IV. Many cases have already been treated with CRT in Japan, however, some challenges still remains, such as difficult placement of the left ventricular (LV. lead at the target site, high threshold values even after successful placement of the LV lead, and the need to reposition of the LV lead due to diaphragmatic stimulation regardless of an appropriate threshold value. In particular, those cases with high threshold values at a distal site or those in which the lead is placed at a proximal site because of diaphragmatic stimulation are prone to lead dislodgement, and re-operation may be required. We report on a patient in whom stabilization of the LV lead was obtained by placing a coronary stent in the coronary sinus wall which resulted in an improved clinical course

Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways

Background: There have been numerous reports about coronary sinus (CS) anomalies related to posteroseptal accessory pathways (APs). The purpose of this study was to explore the diameter and morphology of CS in patients with posteroseptal APs. Methods: We performed direct CS angiography in 105 patients with 22 posteroseptal APs and 83 APs in other regions, and 25 control subjects. We compared the diameter of the CS ostium in all subjects, and assessed the correlation of the local activation time in the patients with posteroseptal APs. Results: The proximal size (diameter) of the CS in the patients with posteroseptal APs (13:6 ± 1:1 mm) was larger than that in the patients with other types of APs (10:2 ± 1:8 mm [p < 0:001]) and that in the control subjects (9:6 ± 1:5 mm [p < 0:001]). Dilatation of the CS in the patients with posteroseptal APs extended up to 20 mm inside the CS. In 15 (68%) of the patients with posteroseptal APs, the proximal site of the CS demonstrated a windsock appearance. Conclusions: We concluded that the larger size and the wind cone appearance of proximal CS were unique structural characteristics in most patients with posteroseptal APs