J. Lindemann

Spontaneous transformation of a concealed to manifest posteroseptal accessory pathway requiring epicardial ablation

Concealed accessory pathways (APs) are considered benign as they can only sustain orthodromic atrioventricular re‐entrant tachycardia (ORT). We describe a unique case of a concealed posteroseptal AP where longitudinal surveillance following repeated failed ablation attempts due to abnormal coronary sinus (CS) anatomy revealed spontaneous development of manifest pre‐excitation. The pathway was ultimately ablated via the percutaneous epicardial approach. The potential for development of Wolff‐Parkinson‐White (WPW) syndrome in patients with concealed APs has implications for ongoing surveillance in these patients.

Systemic Effect of Intrapericardial Triamcinolone Acetate Following Epicardial Mapping and Ablation

lowed up for a period of 610± 536 days. No patient with AT had further AF. One of two patients with slow fast AVNRT had AF reoccurrence and underwent PVI. Five of 10 patients with induced atrial flutter underwent repeat ablation for AF reoccurrence. Conclusion: A significant proportion of young patients presenting with AF have a supra-ventricular tachycardia. Ablation of focal atrial tachycardia or AVNRT prevented AF reoccurrence. In contrast, if the induced arrhythmia was macro-reentry, AF was more common during follow up. In young patients, we advocate the evaluation for a treatable supra-ventricular arrhythmia. http://dx.doi.org/10.1016/j.hlc.2013.05.288