WPW/SVT Via Tricuspid Annulus-Crossing Myocardial Connections Treated by Combined Endocardial-Epicardial Intensive...

Atrioventricular accessory pathways traversing the tricuspid annulus (TA) are well-characterized, typically amenable to ablation with minimal lesions. No morphologically abnormal connections have been previously reported.

A 72-year-old male with 30-year paroxysmal palpitations/chest tightness was diagnosed with type B Wolff-Parkinson-White syndrome and supraventricular tachycardia. After initial radiofrequency catheter ablation (RFCA) failure, enhanced cardiac computed tomography (CT) identified an abnormal connecting structure on the TA free wall. Successful ablation was achieved via a second RFCA incorporating pericardiocentesis and combined endocardial-epicardial ablation.

This is the first report of arrhythmia caused by such abnormal myocardial connections, emphasizing enhanced cardiac CT's diagnostic value and combined endocardial-epicardial ablation's role in refractory cases.

TA-crossing abnormal connections may be a rare cause of refractory Wolff-Parkinson-White/supraventricular tachycardia, requiring combined endocardial-epicardial ablation; enhanced cardiac CT facilitates detection post RFCA failure.