Accessory Pathway Ablation Located Just Below The Bundle of His: A Challenging Case

Puspa Lestari, Ardian Rizal, Yoga Waranugraha


We presented a case of Wolff-Parkinson-White (WPW) Syndrome. A 69-year-old man was admitted for evaluation of frequent episodes of palpitation. The diagnosis of WPW syndrome was established based on the 12-lead surface electrocardiogram (ECG) and electrophysiology (EP) study. We conducted the radiofrequency ablation (RFA) to the accessory pathway (AP). The challenging point of this case was the accessory pathway located just below to the bundle of His, which is related to the risk of complete atrioventricular (AV) block. In summary, we conclude that anatomical consideration, EP study, and the ablation strategy were important to improve the safety and success rate of RFA procedure. 



WPW; AVRT; Anteroseptal accessory pathway; ablation

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Chee YC, Ang JG. A Case of Supraventricular Tachycardia Associated With Wolff-Parkinson-White Syndrome. Journal of Medical Cases. 2018 Jan 27;9(2):54-7.

Teixeira CM, Pereira TA, Lebreiro AM, Carvalho SA. Accuracy of the electrocardiogram in localizing the accessory pathway in patients with Wolff-Parkinson-White pattern. Arquivos brasileiros de cardiologia. 2016 Oct;107(4):331-8.

Ali R, Tahir A, Nadeem M, Shakhatreh MI, Faulknier B. Antidromic Atrioventricular Reentry Tachycardia with Wolff Parkinson White Syndrome: A Rare Beast. Cureus. 2018 May;10(5).

Takemoto M, Origuchi H, Kawagoe J, Harayama N, Soda Y, Yamamoto H, Yoshimura H. Late onset of Wolff-Parkinson-White syndrome in a 72-year-old man. Internal medicine. 2004;43(10):939-44.

Brembilla-Perrot B, N’da OY, Huttin O, Chometon F, Groben L, Christophe C, Benzaghou N, Luporsi JD, Tatar C, Bertrand J, Ammar S. Wolff-Parkinson-White syndrome in the elderly: clinical and electrophysiological findings. Archives of cardiovascular diseases. 2008 Jan 1;101(1):18-22.

Brembilla-Perrot B. Electrophysiological evaluation of Wolff-Parkinson-White Syndrome. Indian pacing and electrophysiology journal. 2002 Oct;2(4):143.

Jung HJ, Ju HY, Hyun MC, Lee SB, Kim YH. Wolff-Parkinson-White syndrome in young people, from childhood to young adulthood: relationships between age and clinical and electrophysiological findings. Korean journal of pediatrics. 2011 Dec;54(12):507.

Sethi KK, Dhall A, Chadha DS, Garg S, Malani SK, Mathew OP. WPW and preexcitation syndromes. JOURNAL-ASSOCIATION OF PHYSICIANS OF INDIA. 2007 Apr;55(R):10.

Daubert JP, Sze E. Mapping and Ablation of Typical and Atypical Accessory Pathways. Cardiac Mapping. 2019 Apr 12:689-716.

Pambrun T, El Bouazzaoui R, Combes N, Combes S, Sousa P, Le Bloa M, Massoullié G, Cheniti G, Martin R, Pillois X, Duchateau J. Maximal Pre-Excitation Based Algorithm for Localization of Manifest Accessory Pathways in Adults. JACC: Clinical Electrophysiology. 2018 May 30:667.

Stephenson EA, Davis AM. Electrophysiology, Pacing, and Devices. InPaediatric Cardiology 2010 Jan 1 (pp. 379-413). Churchill Livingstone.

Huang H, Wang X, Ouyang F, Antz M. Catheter ablation of anteroseptal accessory pathway in the non-coronary aortic sinus. Europace. 2006 Nov 10;8(12):1041-4.

Shenasa M, Hindricks G, Callans DJ, Miller JM, Josephson ME, editors. Cardiac mapping. Futura; 2003 Mar 24.

Wenjuan Z, Zulu W, Ming L, Guitang Y, Zhiqing J, Mingying D. ASSA14-02-11 Catheter ablation of anteroseptal accessory pathway: Implication for the strategies of mapping and ablation.

DiLorenzo MP, Pass RH, Nappo L, Ceresnak SR. Ablating the anteroseptal accessory pathway—ablation via the right internal jugular vein may improve safety and efficacy. Journal of interventional cardiac electrophysiology. 2012 Dec 1;35(3):293-9.



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