Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff--Parkinson--White syndrome

A 45-year-old patient with the Wolff-Parkinson-White syndromesuffering from recurrent intractable reciprocating atrioventriculartachycardia (RAVT) is reported. He used amiodarone, sotalol,quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheterslocalized the site of the anomalous pathway in the ostium ofthe coronary sinus. In this region we could also record a Kentpotential. In the ostium of the coronary sinus, radiofrequencv energy wasrepeatedly applied until the conduction over the accessory pathwaywas abolished both in the anterograde and the retrograde direction.The Kent deflection detectable before ablation, could not bedetected after it. During follow-up (1 month) the patient remainedasymptomatic and the control EPS showed no evidence of pre-excitation,either anterogradely or retrogradely.