Anomalies of the Coronary Venous System in Patients with and without Accessory Pathways

Anomalies of the coronary sinus (CS) were recently reported in association with accessory pathways (APs). In this prospective study, we analyzed the incidence of such anomalies in patients with and without an AP. total of 124 consecutive pts (48 f, 76 m; 43 ± 14 yrs) were investigated; 44 had left free wall AP, 33 posteroseptal AP (10 right; 19 left; 4 without precise location due to failed RFC ablation) and 13 right sided AP (7 anteroseptal; 6 right free wall). The remaining 34 pts were studied for AV nodal reentry tachycardi in 19 cases and for ventricular or atrial arrhythmias in 15 cases. Coronary artery disease was present in 7 pts. Retrograde CS angiography was performed using 6-French catheter. Results: total of 11 anomalies was found, 6 of which were CS diverticul (DIV) and 5 were persistent superior ven cav (PSVC). All were found in pts with APs. 4 DIV were in the posteroseptal (ps) and 1 in the posterior region of the CS. In 4 pts the AP could be abolished from the neck of the DIV, in 2 pts the right ps AP had no association to the ps CS DIV. 4 DIV drained into the CS and 1 directly into the right atrium. 4 DIV were spherical, 1 DIV elliptical and 1 DIV cauliflower-like shaped. The size differed between 1.0 × 1.8 and 3.4 × 2.5 cm. 4 pts with the PSVC had left lateral AP, which could be ablated using the ventricular approach to the mitral valve annulus. 1 pt had right anteroseptal AP, which could be ablated from the right atrium. Conclusions: 1. DIV of the CS are most likely present in patients with left-sided APs. 2. In most cases, an AP is associated with the neck of the DIV. The association between anomalies of the venous system and those of the AV conduction system could be based on combined failures in the embryologic development.