Kimura Kohki, Harita Takeshi, Haruna Tetsuya
Division of Arrhythmia, Medical Research Institute Kitano Hospital, Osaka City, Osaka, Japan.
Pacing Clin Electrophysiol. 2024 Oct;47(10):1373-1376. doi: 10.1111/pace.14977. Epub 2024 Mar 29.
A 51-year-old woman presented with recurring palpitations. Electrocardiography revealed narrow QRS tachycardia with short RP configuration. Computed tomography showed coronary sinus (CS) ostial atresia along with a small persistent left superior vena cava (PLSVC). Electrophysiological study identified the retrograde earliest atrial activation site (EAAS) at the CS ostium without decremental properties, and para-Hisian pacing suggested retrograde atrioventricular nodal conduction. Using a 1.6-Fr microelectrode catheter distally placed in the CS via the PLSVC, EAAS was confirmed within the left atrium, not the CS ostium. Transseptal approach revealed a left lateral accessory pathway, which was successfully eliminated.
一名51岁女性因反复心悸就诊。心电图显示QRS波群狭窄的心动过速，RP间期短。计算机断层扫描显示冠状窦（CS）口闭锁，同时存在一小的永存左上腔静脉（PLSVC）。电生理研究确定CS口为逆向最早心房激动部位（EAAS），且无递减特性，希氏束旁起搏提示逆向房室结传导。通过PLSVC将一根1.6F微电极导管远端置于CS内，证实EAAS位于左心房内，而非CS口。经房间隔途径发现一条左侧旁路，并成功消除。
