Difficult coronary sinus cannulation during cardiac resynchronization therapy due to its diverticulum

Coronary sinus [CS] diverticulum is one the different types of malformations of the right atrium and CS. It can be the primary focus of supraventricular arrhythmias and complicate CS lead implantation during cardiac resynchronization therapy [CRT] device implantation. Herein, we report on a case of CS diverticulum that caused difficulty in CS lead insertion during CRT implantation

Syncope: as a rare presenting feature of atrial flutter

A 42-years-old woman presented with palpitation. Her symptoms aggravated since 2 years ago, and developed palpitation and syncope during its last six months. Her symptoms continued despite the medical therapy. During heart monitoring in CCU, she developed a narrow QRS complex tachycardia with rate of 150 beats/min. After injection of adenosine, ventricular rate slowed down and the flutter waves were appeared. In electrophysiology study [EPS], reverse atrial flutter was induced. Bidirectional cavotricuspid isthmus block by application of radiofrequency energy was done for her. No arrhythmia was induced after radiofrequency ablation. The patient was discharged and during follow up is free of symptoms