Work

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

Year: 2025

Type: article

Abstract: BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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. TAKE-HOME MESSAGE: 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.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106247

Authors: Shaolei Yi, Lianghua Chen

Institutions: Shandong Provincial Hospital, Shandong First Medical University

Language: English

Topic: Cardiac Arrhythmias and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850