{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:58Z","timestamp":1753876198667,"version":"3.41.2"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>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\u2019s palpitations have fully settled with all subsequent electrocardiograms devoid of manifest pre-excitation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab050","type":"journal-article","created":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T06:49:48Z","timestamp":1613717388000},"source":"Crossref","is-referenced-by-count":0,"title":["Abolishment of high-risk left lateral accessory pathway by myocardial infarction: a blessing in disguise? A case report"],"prefix":"10.1093","volume":"5","author":[{"given":"Jim","family":"O\u2019Brien","sequence":"first","affiliation":[{"name":"Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L143PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2086-3690","authenticated-orcid":false,"given":"Nikola","family":"Kozhuharov","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L143PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5620-0798","authenticated-orcid":false,"given":"Shui Hao","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L143PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5082-8944","authenticated-orcid":false,"given":"Mark","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L143PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"key":"2021022216294565500_ytab050-B1","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/eurheartj\/ehz467","article-title":"2019 ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC): Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"41","author":"Brugada","year":"2020","journal-title":"Eur Heart J"},{"key":"2021022216294565500_ytab050-B2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0002-8703(98)70348-5","article-title":"Anatomic and electrophysiologic relation between the coronary sinus and mitral annulus: implications for ablation of left-sided accessory pathways","volume":"135","author":"Shinbane","year":"1998","journal-title":"Am Heart J"},{"key":"2021022216294565500_ytab050-B3","first-page":"1052","article-title":"Maximal pre-excitation based algorithm for localization of manifest accessory pathways in adults","volume":"4","author":"Pambrun","year":"2018","journal-title":"J Am Coll Cardiol Clin Electrophysiol"},{"key":"2021022216294565500_ytab050-B4","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1161\/01.CIR.33.2.317","article-title":"Congenital anomalies involving the coronary sinus","volume":"33","author":"Mantini","year":"1966","journal-title":"Circulation"},{"key":"2021022216294565500_ytab050-B5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ipej.2019.09.003","article-title":"A curious case of impossible coronary sinus cannulation","volume":"19","author":"Krishnamurthy","year":"2019","journal-title":"Indian Pacing Electrophysiol J"},{"key":"2021022216294565500_ytab050-B6","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1161\/01.CIR.0000028464.12047.A6","article-title":"Coronary sinus-ventricular accessory connections producing posteroseptal and left posterior accessory pathways: incidence and electrophysiological identification","volume":"106","author":"Sun","year":"2002","journal-title":"Circulation"},{"key":"2021022216294565500_ytab050-B7","first-page":"43","article-title":"Successful ablation of a left-sided accessory pathway in a patient with coronary sinus atresia and arteriovenous fistula: clinical and developmental insights","volume":"11","author":"Patel","year":"2011","journal-title":"Indian Pacing Electrophysiol J"},{"key":"2021022216294565500_ytab050-B8","article-title":"Mapping of a left lateral accessory pathway with a high-density multipolar mapping catheter","volume":"20","author":"Navarette","year":"2020","journal-title":"EP Lab Digest"},{"key":"2021022216294565500_ytab050-B9","first-page":"145","article-title":"A young woman with recurrent palpitations: a case of Ebstein anomaly with Mahaim fiber tachycardia","volume":"3","author":"Viray","year":"2019","journal-title":"CASE (Phila)"},{"key":"2021022216294565500_ytab050-B10","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1093\/eurheartj\/ehr117","article-title":"High incidence of acute sub-clinical circumflex artery \u2018injury\u2019 following mitral isthmus ablation","volume":"32","author":"Wong","year":"2011","journal-title":"Eur Heart J"},{"key":"2021022216294565500_ytab050-B11","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.ijcard.2005.03.061","article-title":"Wolff-Parkinson-White syndrome and myocardial infarction: a case report","volume":"108","author":"Astorri","year":"2006","journal-title":"Int J Cardiol"},{"key":"2021022216294565500_ytab050-B12","doi-asserted-by":"crossref","first-page":"e12735","DOI":"10.1111\/anec.12735","article-title":"Concealed Wolff-Parkinson-White syndrome revealed by acute coronary syndrome","volume":"25","author":"Castro","year":"2020","journal-title":"Ann Noninvasive Electrocardiol"},{"volume-title":"StatPearls [Internet]","year":"2020","author":"Chhabra","key":"2021022216294565500_ytab050-B13"}],"container-title":["European Heart Journal - 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