Approach to the difficult septal atrioventricular accessory pathway: the importance of regional anatomy.

Ablation of accessory tracts in the posteroseptal region can be challenging, as illustrated by these 2 cases. Familiarity of the anatomy of this region and recognition of the ECG patterns can help identify the AP origin and potentially improve success rates of ablation. The isoelectric initial preexcited QRS complex with rSR’ pattern in lead V1 of the surface ECG but not the relatively earlier local ventricular activation at PSMA region may indicate a left-sided ablation approach for these APs.