PO-04-077 EPICARDIAL ABLATION OF A PREVIOUSLY FAILED RIGHT LATERAL ACCESSORY PATHWAY

Catheter ablation is a potentially curative treatment for accessory pathways. However, of right lateral pathways challenging and has lower procedural success rate high recurrence due to catheter instability difficulty in manipulation, inadequate tissue contact structural heart disease like Ebstein's anomaly. We describe case WPW syndrome with pathway, where the pathway was located epicardially. N/A A 23-year-old female history recurrent palpitations evaluated diagnosed as free wall structurally normal biventricular function failed twice 2018 2020. In view symptoms, patient started on anti-arrhythmic therapy. As refractory flecainide, sotalol amiodarone , she referred our center repeat ablation. Baseline ECG showed manifest pre-excitation. standard electrophysiology study performed under general anaesthesia sequential endocardial epicardial mapping approach. Retrograde ERP (effective period) 240 ms whereas antegrade 340 (on anaesthesia). Orthodromic atrio-ventricular reciprocating tachycardia easily induced by programmed stimulation cycle length 470 earliest atrial electrogram noted atrium. despite extensive tricuspid annulus, at site terminate tachycardia. Hence, access obtained using Sosa’s tenchique along annulus performed. At epicardially, fused ventricular signals were local signal preceding surface delta wave 35 ms. Right coronary angiography revealed safe distance between artery Epicardial this led loss conduction within 5 seconds. Post ablation, no inducible aggressive pacing protocols bidirectional AV block demonstrated intravenous adenosine. 1-year follow-up, asymptomatic evidence conduction. should be considered previously cases