Radiofrequency ablation of an atypical left accessory pathway from the left coronary cusp

Masquerade: An unusual accessory pathway with ventricular insertion at the right–left sinus of Valsalva mimicking outflow tract ventricular tachycardia

“…At least 4 cases of APs ablated successfully in the left aortic sinus of Valsalva have been reported, 2 that were anterograde only 3 , 4 and 2 that were bidirectional. 1 , 2 These pathways can be adenosine-sensitive by report. 4 We report a unique and, to our knowledge, unreported slowly conducting, nondecremental, anterograde-only AP with insertion into the right–left aortic sinus of Valsalva.…”

“…Although rare, an accessory pathway (AP) can have a ventricular insertion in the region of the aortic sinuses of Valsalva. 1 , 2 , 3 , 4 This can be difficult to diagnose and may resemble outflow tract ventricular tachycardia (VT). 4 Despite the existence of various algorithms that can differentiate wide-complex supraventricular tachycardia (SVT) from VT, these conditions may be impossible to differentiate based on surface QRS morphology alone.…”