Atriofascicular pathway in Ebstein's anomaly: Revisiting the role of preoperative EP studies in pediatrics

We present a case of a 6-year-old with Ebstein's anomaly (EA) who was found to have a right lateral decremental, antegrade only accessory pathway (AP), presumed atriofascicular AP, during a pre-operative electrophysiology study (EPS) prior to da Silva Cone repair (CR). Atriofascicular APs represent <3 % of APs but have an association with EA. To the best of our knowledge, this is the youngest reported case of EA with an atriofascicular AP. Providers should be aware of this possibility, as CRs are being done at younger ages, and they may be discovered in asymptomatic patients.