Excerpt

A 20-year-old man with manifest Wolff-Parkinson-White syndrome was referred for catheter ablation. He had recurrences after two previous sessions for multiple accessory pathways (AP) with suspected Ebstein’s anomaly. The electrophysiological study confirmed the diagnosis of manifest right posterolateral AP (Fig. 1). A 64-pole mini-electrode basket catheter was advanced to the right atrium, and automated mapping was performed using the Rhythmia™ system. The activation map shows that the earliest breakthrough point at the posterolateral site of the right ventricle was clearly determined (Fig. 2 and Supplemental Video). No other AP or supraventricular tachycardia was detected. Ablation was applied by using a non-irrigated 4-mm tip ablation catheter, and the residual AP successfully disappeared within 1 s after the first ablation with the power of 30 W. At the 2-month follow-up, the patient was free from any arrhythmia, and manifest Wolff-Parkinson-White syndrome was absent on electrocardiography.

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