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Radiofrequency catheter ablation of a right atriofascicular (Mahaim) and two atrioventricular (Kent) accessory
J Hluchy1, M Wieczorek, M Tekiyeh
1Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany.
Insights
This case study details a 19-year-old with Ebstein's anomaly and multiple accessory pathways causing complex tachycardias. Radiofrequency ablation successfully treated all pathways in one session.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Ebstein's anomaly is a congenital heart condition affecting the tricuspid valve.
- Accessory pathways can cause supraventricular tachycardias.
- Complex accessory pathway anatomy poses treatment challenges.
Observation:
- A 19-year-old patient with Ebstein's anomaly presented with unusual right atriofascicular (Mahaim) and two ipsilateral right atrioventricular (Kent) accessory pathways.
- The patient experienced multiple types of antidromic and orthodromic reciprocating tachycardias.
- Retrograde conduction over the His-Purkinje system was absent.
Findings:
- Three distinct accessory pathways were identified in the patient.
- All identified pathways participated in the complex tachyarrhythmias.
- Temperature-guided radiofrequency ablation successfully eliminated all three pathways in a single session.
Implications:
- This case highlights the possibility of multiple accessory pathways in Ebstein's anomaly.
- Successful single-session ablation of complex accessory pathways is feasible.
- This approach offers a potentially curative treatment for associated tachycardias.
Abstract:
This report describes the case of a 19-year-old patient with Ebstein's anomaly, who had an unusual combination of a right atriofascicular (Mahaim) and two ipsilateral right atrioventricular (Kent) accessory pathways participating in three types of antidromic and orthodromic reciprocating tachycardias in the absence of retrograde conduction over the bundle of His-atrioventricular node axis. All three pathways were ablated in a single session using temperature-guided radiofrequency current.