■顺行左外侧辅助途径是室上性心动过速和预激心房颤动的风险。很少,异常冠状窦会导致路径定位困难。左回旋支冠状动脉和钝的边缘分支供应左心室后外侧。我们描述了与异常冠状窦相关的高风险辅助途径的病例报告,在连续的电生理学研究之间,在左回旋区被适当的急性冠状动脉综合征所消除。
■一名49岁男性心悸并明显预激,被转诊为电生理学研究。初步研究显示,高风险的左外侧辅助途径,顺行有效不应期为240ms,并迅速进行预激发房颤。冠状窦无法插管以定位路径。冠状动脉造影和心脏计算机断层扫描显示异常的冠状窦排空到右心房游离壁和冠状动脉通畅。在等待重复的电生理研究时,患者患有急性冠状动脉综合征,心电图上立即丧失先前可见的预激,并接受了回旋弯曲的边缘分支的支架置入术。重复电生理学研究显示了现在的低风险辅助途径(有效不应期390ms)。自从梗塞以来,患者的心悸已经完全稳定,所有随后的心电图都没有明显的预激。
■左侧辅助通道,这可能与异常冠状窦有关,来自与正常心室心肌相似的组织,并且在回旋支动脉对向区域易受缺血性损伤。
BACKGROUND: Antegradely conducting left lateral accessory pathways are a risk for supraventricular tachycardias and pre-excited atrial fibrillation. Rarely, an anomalous coronary sinus can cause difficulty in locating the pathway. The left circumflex coronary artery and obtuse marginal branches supply the posterolateral left ventricle. We describe a
case report of a high-risk accessory pathway associated with an anomalous coronary sinus which, between successive electrophysiology studies, was obliterated by a felicitous acute coronary syndrome in the left circumflex territory.
METHODS: A 49-year-old male with palpitations and manifest pre-excitation was referred for electrophysiology study. Initial study revealed a high-risk left lateral accessory pathway with antegrade effective refractory period of 240 ms and rapidly conducting pre-excited atrial fibrillation. The coronary sinus could not be cannulated to localize the pathway. Coronary angiography and cardiac computed tomography showed an anomalous coronary sinus emptying into the right atrial free wall and patent coronaries. While awaiting repeat electrophysiology study, the patient suffered an acute coronary syndrome with immediate loss of previously visible pre-excitation on electrocardiogram, and underwent stenting of an occluded marginal branch of the circumflex. Repeat electrophysiology study demonstrated a now low-risk accessory pathway (effective refractory period 390 ms). Since infarction, the patient\'s palpitations have fully settled with all subsequent electrocardiograms devoid of manifest pre-excitation.
CONCLUSIONS: Left lateral accessory pathways, which can associate with an anomalous coronary sinus, derive from tissue similar to normal ventricular myocardium and are vulnerable to ischaemic insults in the area subtended by the circumflex artery.