Catheter ablation of an atrioventricular bypass tract connecting a funnel-shaped bilobular left atrial appendage with the ventricular free wall.

摘要

A female patient with Wolff-Parkinson-White syndrome and frequent episodes of atrioventricular reentrant tachycardia was referred for electrophysiologic evaluation and in-terventional treatment. Twelve-lead surface ECG showed preexcitation with a negative delta wave in leads I and aVL and positive delta waves in the inferior leads and leads V_1-V_6, indicating a left posterior accessory pathway (AP) localization. After confirmation of a left posterior AP localization by an eccentric activation in the coronary sinus (CS) during both sinus rhythm and retrograde stimulation, the left atrium (LA) was accessed via a transseptal puncture for an anterograde approach. Earliest endocardial activation was found at the superoposterior aspect of the mitral annulus. However, radiofrequency (RF) delivery at that site with a maximal power of 40 W failed to eliminate the AP.