Atrial Double Potentials Associated With the Elimination of the Electrical Connection Between the Coronary Sinus (CS) and the Left Atrium in Two Cases of Wolff-Parkinson-White Syndrome With a CS-Connected Accessory Pathway

  • Enjoji Yoshihisa
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Sugi Kaoru
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Tezuka Naoki
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Nakae Takeshi
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Takami Mitsuaki
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Sakata Takao
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Noro Mahito
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Ikeda Takanori
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan
  • Yamaguchi Tetsu
    Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan

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A curious retrograde conduction in connection with the coronary sinus (CS) musculature was observed in 2 patients. After the failed ablation procedure, the atrial electrogram during ventricular pacing presented double potentials, the first component of which was sharp and with an activation sequence that was the same before ablation (CS distal to proximal). The second component of the double potentials was dull and had a decremental property; its activation sequence was in reverse (proximal to distal). In both cases, the first component disappeared after successful ablation. These findings suggest that the first component was the CS electrogram conducted over the accessory pathway and the second component was the left atrial electrogram conducted through the inter-atrial septum. The separation of each electrogram is probably the result of a block between the accessory pathway connected to the CS musculature and the left atrium. These are unusual cases of an accessory pathway connected to the CS musculature, which separates the left atrial myocardium at the distal portion from the ostium.

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