Anatomy for EP Flashcards
What is the name of the venous valve in the mid-coronary sinus and what is it’s clinical significance?
Valve of Vieussens. This is the ostial valve of the great cardiac vein and can impairs the ability to place catheters into the distal coronary sinus.
What are the major tributaries of the coronary sinus?
Name 5 tricks to get past the valve of Vieussens.
- Gently insert and with draw the catheter while probing the circumference of the valve with the intent of “falling” through when you get to the raphe (tip by David Reuter)2. If you can get a diagnostic catheter past the valve, use the buddy system3. Use an SL2 sheath and a glide wire (Tip by Krisp)4. Track a Mullins sheath over a catheter in the CS, then remove the catheter a replace the dilator. use the dilator to get the sheath past the valve of Vieussens, then replace (Tip from Jordan)5. Note, the coronary sinus constricts with atrial systole. In cases where getting across the valve of Veiussens is problematic, I wonder if a dose of adenosine would help?
Where does the HIS bundle penetrate the AV junction in ccTGA?
Where there is fiberous continuity between the pulmonary and mitral valves
Not all bypass tracts span the AV groove. Name 3 bypass tracts that can frustrate an afib ablation.
- VOM to LPV
- LAA to LPV
- SVC to RPV
Samuel J. Asirvatham, MD; William G. Stevenson, MD CIRC EP 2014
There are 2 areas of specialized conduction elements seen in DILV. Where are they and which is active?
There is a postrior “node” which is anterior to the CS in the typical position - this node is not connected. The functional node is anterior between the RAA and atrial septum and coursed to the AV bundle which pierces the fiberous ring adjacent to the pulmonary valve.
Pacing from which of the aortic cusps results in atrial capture?
The Non-coronary cusp abuts the atrial septum, thus pacing from here results in atrial capture. It is also possible to ablate some forms of SVT from this location.
