Catheter ablation of the anteroseptal accessory pathway from the non-coronary aortic cusp in a pediatric patient

A challenging catheter ablation of anteroseptal manifest accessory pathway from non-coronary aortic cusp in a paediatric patient

“…Failed cryoablation attempt or recurrence after cryoablation has been reported. 2,4 In patients with successful cryo or RF ablation, unusual locations with deep epicardial locations (especially aortic non-coronary cusp) may be present in possible recurrence. In our patient, although AP was successfully eliminated by both cryo and RF via the right-sided femoral and jugular pathways, recurrence occurred in a short time.…”

“…Here, we present a case of Wolff-Parkinson-White syndrome with an oblique and deep-seated anteroseptal accessory pathway in which ablation was successfully performed from non-coronary aortic cusp. [1][2][3][4] Case presentation A 10-year-old male patient was admitted to a paediatrician with a complaint of palpitations. Wolff-Parkinson-White syndrome was detected in his ECG, and sotalol treatment was started.…”

Catheter ablation of anteroseptal accessory pathways from the aortic cusps: A case series and a review of the literature

“…A comprehensive literature search of relevant studies published in MEDLINE up to November 2015 was additionally conducted. Sixteen case studies [3–18] comprising 36 patients with septal APs successfully ablated through the aortic cusps were included in this analysis. In most of these cases, a right‐sided approach was initially undertaken and had been unsuccessful highlighting the importance of recognizing the presence of an aortic cusp pathway when present.…”

“…In previous studies, there were no embolic events following RF ablation within the cusps [3–18]. However, based on the clinical experience during ablation of other left sided arrhythmias, a more prudent strategy is to use cooled RF ablation or cryoablation within the aortic cusps in order to minimize the risk of thrombus formation [27].…”

“…Anteroseptal APs are rare but associated with lower success rates and higher incidence of atrioventricular (AV) block [1,2]. Data regarding the electrocardiographic and electrophysiological characteristics as well as the safety and efficacy of catheter ablation of anteroseptal APs through the aortic cusps are limited [3–18]. We describe two cases of para‐Hisian APs successfully ablated from the aortic cusps along with a detailed review of the current literature.…”