Failed Posteroseptal Accessory Pathway. Where to Ablate?

摘要

This article describes a patient with a retrograde-only posteroseptal accessory pathway (AP) who presented with recurrent palpitations and supraventricular tachycardia (SVT) despite 3 previous attempts at catheter ablation. The patient failed ablation in the right atrium as well as left atrium through transseptal and retrograde aortic approaches. The key to success was occlusive coronary sinus venography showing an abnormal small cardiac vein through retrograde filling. This vein was the site of earliest atrial activation, which served as the target for successful ablation of the AP. The patient has remained free of palpitations and SVT for more than 6 months.