Successful radiofrequency catheter ablation of a right posterolateral bypass tract in a patient with Wolff-Parkinson-White syndrome after a previous failed ablative procedure: Taking the high road

A 16-year-old high school basketball player with symptomatic Wolff-Parkinso n-White syndrome underwent an unsuccessful radiofrequency catheter ablative procedure from the femoral venous approach. During this procedure, the pat ient received 30 applications of radiofrequency energy without injury to th e accessory pathway. The patient was treated with flecinide 100 mg orally t wice daily and rescheduled for a second ablative procedure via the right in ternal jugular venous approach. At the second session, prior to any right i nternal jugular venous applications, 3 additional applications were deliver ed via the right femoral venous approach using a different catheter, withou t success. A single radiofrequency energy application from the right intern al jugular venous approach eliminated the bypass tract in approximately 2 s econds. The superior approach achieved a more stable catheter position ther eby eliminating the bypass tract, In conclusion, an alternative plan of att ack should be considered after multiple failures from a given approach. In other words, take the high road if you can't take the low road.