Radiofrequency ablation of a right atrial appendage-ventricular accessory pathway by transcutaneous epicardial instrumentation

Ablation of RAA-Ventricular AP. Epicardial location of accessory AV pathway s may be responsible for the failure of conventional endocardial radiofrequ ency catheter ablation. Transcutaneous epicardial instrumentation provides access to the normal pericardium with no need for invasive thoracotomy or t horacoscopy. We report the case of successful epicardial mapping and ablati on of a right atrial appendage-ventricular connection using a percutaneous epicardial approach, after repeated failure of endocardial ablation attempt s.