ABLATION OF MULTIPLE ATRIOVENTRICULAR ACC ESSORY PATHWAYS IN A PATIENT WITH SYNCOPE, ATRIAL-FIBRILLATION AND FASCICULO-VENTRICULAR FIBERS

Multiple accessory pathways in patients with the Wolff-Parkinson-White syndrome are infrequent and are associated with a higher risk of vent ricular fibrillation. We present an exceptional case of a patient with four accessory pathways with anterograde conduction and a fasciculo-v entricular fiber in whom we performed a radiofrequency ablation. A 20 year old healthy male patient was seen at the emergency room after suf fering syncope. The electrocardiogram showed atrial fibrillation with wide QRS complex suggestive of preexcitation. The electrophysiologic s tudy demostrated the presence of four atrio-ventricular accessory path ways with antegrade conduction (left lateral, right posteroseptal, rig ht midseptal and right posterolateral). After ablation of the fourth a ccessory pathway, the electrocardiogram showed a persistent delta wave with a short HV interval. Atrial stimulation demonstrated decremental conduction, progressive lengthening of the AII interval and no modifi cation in the HV interval nor in the preexcitation pattern, suggestive of the presence of a fasciculo-ventricular fiber. This exceptional ca se report is demonstrative of the complexity of the Wolff-Parkinson-Wh ite syndrome, and the feasibility and efficacy of radiofrequency cathe ter ablation in a single procedure.