Wolff-Parkinson-White syndrome due to a left atrial appendage–to–left ventricular connection: A case of a successful pathway elimination from inside of the left atrial appendage

Rare accessory pathway between a giant left atrial appendage and the left ventricle

“…The placement of a CS catheter in the anterior interventricular vein could help us diagnose this AP. 1,5 In our case, it was hard to diagnose the LAA-LV AP owing to multiple APs, including right-sided APs. However, the preexcited QRS wave during a PAC, giant LAA, and electrogram in the anterior intraventricular vein helped us to diagnose this AP.…”

“…The ablation of LAA-LV APs is difficult because of (1) their rarity, (2) broad APs, (3) the tip of the LAA being associated with multiple APs, and (4) the close vicinity to the coronary artery. 1,5 Though multiple APs make predicting the AP location confusing, an LAA-LV AP should be suspected when a giant LAA exists or the 12-lead ECG exhibits a preexcited QRS that originates from the left lateral wall. The placement of a CS catheter in the anterior interventricular vein could help us diagnose this AP.…”

“…Its features include the potential of causing ventricular fibrillation (VF) owing to a short effective refractory period (ERP) of the AP and the coexistence of multiple APs or an AP between the right atrial appendage and right ventricle, and it can cause difficulty in performing endocardial ablation. [1][2][3][4][5][6][7] We report a case of a 6-year-old boy with multiple APs including an LAA-LV AP, giant LAA, and LV noncompaction (LVNC). Little has been reported on LAA-LV APs associated with a giant LAA.…”

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

“…Left‐side APs with atrial insertion away from the MA are an atypical variation, and there are only a few cases have been reported. Several prior reports have demonstrated left‐sided pathways were successfully ablated at the base of LAA and the roof of LA with atrial insertion away from the MA 3–6 . But there are no reports of atrial insertion sites at atrial septum, especially at the FO.…”

Detection of an epicardial accessory pathway using the novel algorithm during ultra-high-density mapping

“…Mah and colleagues 9 reported 3 cases, all of which had a very short AP effective refractory period below 200 ms. Those patients were surgically treated because they had broad or multiple connections to the LV and left coronary artery injury caused by high-power RF delivery was of concern. Later, Benhayon and colleagues 10 reported a pediatric case in which the AP was successfully ablated by an irrigation catheter after confirming that the ablation site was distant from the coronary artery by using intracardiac echocardiography. Besides, the proximity to the coronary artery was less likely because the ablation site was not in the left atrial appendage and the ablation was completed without any complications.…”