Successful radiofrequency catheter ablation of a right posterolateral bypass tract in a patient with Wolff-Parkinson-White syndrome after a previous failed ablative procedure: taking the high road.
A 16-year-old high school basketball player with symptomatic Wolff-Parkinson-White syndrome underwent an unsuccessful radiofrequency catheter ablative procedure from the femoral venous approach. During this procedure, the patient received 30 applications of radiofrequency energy without injury to the accessory pathway. The patient was treated with flecinide 100 mg orally twice daily and rescheduled for a second ablative procedure via the right internal jugular venous approach. At the second session, prior to any right internal jugular venous applications, 3 additional applications were delivered via the right femoral venous approach using a different catheter, without success. A single radiofrequency energy application from the right internal jugular venous approach eliminated the bypass tract in approximately 2 seconds. The superior approach achieved a more stable catheter position thereby eliminating the bypass tract. In conclusion, an alternative plan of attack should be considered after multiple failures from a given approach. In other words, take the high road if you can't take the low road.
Cohen
T J
TJ
Division of Cardiology, Department of Medicine, Winthrop University Hospital, Mineola, New York, USA. Tcohen@winthrop.org.
D000293:Adolescent; D006328:Cardiac Catheterization / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D017023:Coronary Angiography; D004562:Electrocardiography; D005263:Femoral Artery; D006329:Heart Conduction System / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D012086:Reoperation; D014927:Wolff-Parkinson-White Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*