Successful cryoablation in the noncoronary aortic cusp for a left anteroseptal accessory pathway

Catheter ablation of anteroseptal accessory pathways may be difficult because of the neighboring conduction tissue that may be damaged with ablation. We report a case of an accessory pathway localized to the anteroseptal region. A pathway potential found in the noncoronary cusp of the aortic valve was successfully targeted for ablation with cryo energy. Observations during tachycardia and pacing maneuvers suggest that the supravalvar aortic musculature may be an integral component of left anteroseptal pathways that can be safely targeted for cryoablation without injury of the atrioventricular conduction system.