RADIOFREQUENCY CATHETER ABLATION OF AN AC CESSORY PATHWAY WITH PERSISTENT LEFT SUPERIOR VENA-CAVA AND HYPERTROPHIC CARDIOMYOPATHY

A 43-year-old man with a 30-year history of WPW-syndrome and a hypertr ophic cardiomyopathy developed acute heart failure after onset of atri al fibrillation with fast antegrade conduction, which could be convert ed to sinus rhythm with antiarrhythmic medication. Catheterization of the coronary sinus during EP testing demonstrated a persistent left su perior vena cava. The accessory pathway could be localized at the orif ice of an atypical epicardial vein. It was successfully abolished afte r subvalvular placement of the electrode catheter in the left ventricl e. This constellation indicates a combined defect during the regressio n of the sinus venosus to the sinus coronarius with persistence of con ducting muscle fibers. Successful RF ablation procedure provides an ob vious risk reduction as a result of a lower frequency of atrial fibril lation and the eliminated risk of ventricular fibrillation due to rapi d conduction via an accessory pathway. Beyond that, harmless therapeut ic treatment of hypertrophic cardiomyopathy with a calcium-channel-blo cker (verapamil type) can follow RF ablation.