Rare left-sided accessory pathway successfully ablated with atrial insertion site at the left-side fossa ovalis

J Cardiovasc Electrophysiol. 2022 Oct;33(10):2224-2227. doi: 10.1111/jce.15634. Epub 2022 Sep 7.

Abstract

Introduction: Left-sided accessory pathway (AP) with atrial insertion away from the annulus is an atypical variation. Conventional mapping and ablation performed along mitral annulus (MA) is usually ineffective.

Methods: A 14-year-old girl without structural heart disease presented with recurrent episodes of sudden onset palpitations and electrocardiogram (ECG) showed a narrow QRS complex tachycardia.

Results: Electrophysiology study (EPS) was done and anterograde atrioventricular reentrant tachycardia (AVRT) with AP was diagnosed. Conventional mapping and ablation performed along TA and MA was failed. 3D-activation mapping found the retrograde atrial insertion site of AP on the left atrium fossa ovalis (FO), and AP was successfully abolished by radiofrequency ablation at that site.

Conclusion: As reported, this patient is the first report of ablating a left-sided AP with retrograde atrial insertion on the left atrium FO.

Keywords: accessory pathway; anterograde AVRT; catheter ablation; fossa ovalis.

Publication types

  • Case Reports

MeSH terms

  • Accessory Atrioventricular Bundle* / surgery
  • Adolescent
  • Catheter Ablation*
  • Electrocardiography
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / surgery
  • Humans
  • Tachycardia / surgery
  • Tachycardia, Atrioventricular Nodal Reentry* / diagnosis
  • Tachycardia, Atrioventricular Nodal Reentry* / surgery