Recurrent Tachycardia in a Patient with Left Lateral Wolff-Parkinson-White Syndrome

摘要

This article describes a patient with Wolff-Parkinson-White syndrome associated with left lateral accessory pathway (AP) who presented with recurrent palpitations and supraventricular tachycardia despite 3 previous catheter ablations. Based on differential pacing maneuvers from the posterior basal right ventricle and anterior interventricular vein (AIV), the presence of a slanted AP was demonstrated. Pacing from the AIV created a ventricular activation wavefront along the coronary sinus catheter in a direction opposite to that of AP activation, allowing separation of ventricular and atrial activation signals, and mapping and successful ablation of the AP potential at the ventricular insertion site.