WPW pathway ablated from uncommon location

Dr. T. Joseph^*

Consultant Interventional Cardiologist & Electrophysiologist, Kauvery Hospital, Trichy â€“ Heartcity, India

Drug resistant SVT due to WPW syndrome in a 17-year-old with history of failed ablation because of high risk location of the accessory pathway.

Figures 1-5 illustrate the successful performance of a high-risk procedure from an unusual location.

Fig. 1. Anteroseptal pathway – pre-ablation ECG.

Fig. 2. Localisation of pathways.

Fig. 3. Post ablation (DELTA lost).

Fig. 4. Ablation spot in aortic CUSP (near right coronary artery – RCC).

Fig. 5. Fused electrical signals at NCC – RCC site.

Anteroseptal and midseptal pathway are close to AV node and Bundle of HIS
Ablating them directly can result in AV BLOCK.
Aortic cusp gives a vantage point to access these accessory pathways.
Our case is one example where we were very close to Right coronary but lucky to get rid of the pathway.

Dr. T. Joseph
Consultant Interventional Cardiologist & Electrophysiologist

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