Radiofrequency ablation of posteroseptal accessory pathways associated with coronary sinus diverticula

  • Raja J. SelvarajEmail author
  • Krishna Sarin
  • Vivek Raj Singh
  • Santhosh Satheesh
  • Ajith Ananthakrishna Pillai
  • Mahesh Kumar
  • Jayaraman Balachander



Posteroseptal accessory pathways may be associated with a coronary sinus (CS) diverticulum. Our purpose was to describe the clinical characteristics, mapping and ablation of these pathways.


This was a retrospective study of all patients who underwent ablation of posteroseptal accessory pathways in a single centre. Patients with a diverticulum of the CS or one of its tributaries were included in group I, while the other patients formed group II. Clinical presentation, ablation procedure and outcome were compared between the two groups.


A total of 51 patients were included, 16 in group I and 35 in group II. There were no significant differences in age or sex distribution. Atrial fibrillation (AF) and previous unsuccessful ablation were more common in group I. A negative delta wave in lead II was the ECG finding with best sensitivity and specificity for the presence of a diverticulum. A pathway potential was common at the successful site in group I, and the interval between local ventricular electrogram and delta wave onset was shorter (19.5 ± 8 vs 33.1 ± 7.6 ms, p < 0.001). There was a trend toward lower procedural success rate and higher recurrence rate in group I, although this was not significant.


CS diverticula should be suspected in patients with manifest posteroseptal accessory pathways who have a previous failed ablation, documented AF or typical electrocardiographic signs. A discrete potential is frequently seen at the successful site, but the local ventricular electrogram is not as early as in other accessory pathways.


Coronary sinus Diverticulum WPW Ablation Posteroseptal 


Compliance with ethical standards

None of the authors have any potential conflict of the interest directly or indirectly related to this study. This study involves human participants and was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was not obtained from individual participants as this was a retrospective study from case records.


None for any of the authors

Financial support



  1. 1.
    Takahashi, A., Shah, D. C., Jaïs, P., Hocini, M., Clementy, J., & Haïssaguerre, M. (1998). Specific electrocardiographic features of manifest coronary vein posteroseptal accessory pathways. Journal of Cardiovascular Electrophysiology, 9(10), 1015–1025.CrossRefPubMedGoogle Scholar
  2. 2.
    Gerlis, L. M., Davies, M. J., Boyle, R., Williams, G., & Scott, H. (1985). Pre-excitation due to accessory sinoventricular connexions associated with coronary sinus aneurysms. A report of two cases. British Heart Journal, 53(3), 314–322.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Di Segni, E., Siegal, A., & Katzenstein, M. (1986). Congenital diverticulum of the heart arising from the coronary sinus. British Heart Journal, 56(4), 380–384.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Guiraudon, G. M., Guiraudon, C. M., Klein, G. J., Sharma, A. D., & Yee, R. (1988). The coronary sinus diverticulum: a pathologic entity associated with the Wolff-Parkinson-White syndrome. American Journal of Cardiology, 62(10 Pt 1), 733–735.CrossRefPubMedGoogle Scholar
  5. 5.
    Arruda, M. S., McClelland, J. H., Wang, X., Beckman, K. J., Widman, L. E., Gonzalez, M. D., et al. (1998). Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. Journal of Cardiovascular Electrophysiology, 9(1), 2–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Sun, Y., Arruda, M., Otomo, K., Beckman, K., Nakagawa, H., Calame, J., et al. (2002). Coronary sinus-ventricular accessory connections producing posteroseptal and left posterior accessory pathways: incidence and electrophysiological identification. Circulation, 106(11), 1362–1367.CrossRefPubMedGoogle Scholar
  7. 7.
    Ho, S. Y., Russell, G., & Rowland, E. (1988). Coronary venous aneurysms and accessory atrioventricular connections. British Heart Journal, 60(4), 348–351.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Weiss, C., Cappato, R., Willems, S., Meinertz, T., & Kuck, K. H. (1999). Prospective evaluation of the coronary sinus anatomy in patients undergoing electrophysiologic study. Clinical Cardiology, 22(8), 537–543.CrossRefPubMedGoogle Scholar
  9. 9.
    Tebbenjohanns, J., Pfeiffer, D., Schumacher, B., Jung, W., Manz, M., & Lüderitz, B. (1996). Direct angiography of the coronary sinus: impact on left posteroseptal accessory pathway ablation. Pacing and Clinical Electrophysiology, 19(7), 1075–1081.CrossRefPubMedGoogle Scholar
  10. 10.
    Haghjoo, M., Mahmoodi, E., Fazelifar, A. F., Alizadeh, A., Hashemi, M. J., Emkanjoo, Z., & Sadr-Ameli, M. A. (2008). Electrocardiographic and electrophysiologic predictors of successful ablation site in patients with manifest posteroseptal accessory pathway. Pacing and Clinical Electrophysiology, 31(1), 103–111.CrossRefPubMedGoogle Scholar
  11. 11.
    Hamilton, K., Castillo, M., Arruda, M., & Jackman, W. (1996). Echocardiographic demonstration of coronary sinus diverticula in patients with Wolff-Parkinson-White syndrome. Journal of the American Society of Echocardiography, 9(3), 337–343.CrossRefPubMedGoogle Scholar
  12. 12.
    Raatikainen, M. J. P., & Pedersen, A. K. (2010). Catheter ablation of a difficult accessory pathway guided by coronary sinus venography and 3D electroanatomical mapping. Europace, 12(8), 1200–1201.CrossRefPubMedGoogle Scholar
  13. 13.
    Payami, B., Shafiee, A., Shahrzad, M., Kazemisaeed, A., Davoodi, G., & Yaminisharif, A. (2013). Posteroseptal accessory pathway in association with coronary sinus diverticulum: electrocardiographic description and result of catheter ablation. Journal of Interventional Cardiac Electrophysiology, 38(1), 43–49.CrossRefPubMedGoogle Scholar
  14. 14.
    Jazayeri, M. R., Dhala, A., Deshpande, S., Blanck, Z., Sra, J., & Akhtar, M. (1995). Posteroseptal accessory pathways: an overview of anatomical characteristics, electrocardiographic patterns, electrophysiological features, and ablative therapy. Journal of Interventional Cardiology, 8(1), 89–101.CrossRefPubMedGoogle Scholar
  15. 15.
    Gatzoulis, K. A., Apostolopoulos, T., Costeas, X., Zervopoulos, G., Papafanis, F., Sotiropoulos, H., Gialafos, J., & Toutouzas, P. (2001). Radiofrequency catheter ablation of posteroseptal accessory pathways--results of a step-by-step ablation approach. Journal of Interventional Cardiac Electrophysiology, 5(2), 193–201.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Raja J. Selvaraj
    • 1
    Email author
  • Krishna Sarin
    • 1
  • Vivek Raj Singh
    • 1
  • Santhosh Satheesh
    • 1
  • Ajith Ananthakrishna Pillai
    • 1
  • Mahesh Kumar
    • 1
  • Jayaraman Balachander
    • 1
  1. 1.Department of CardiologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia

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