WPW pathway ablated from uncommon location

Dr. T. Joseph*

Consultant Interventional Cardiologist & Electrophysiologist, Kauvery Hospital, Trichy – Heartcity, India

*Correspondence: josephtheodore84@gmail.com


Drug resistant SVT due to WPW syndrome in a 17-year-old with history of failed ablation because of high risk location of the accessory pathway.

Figures 1-5 illustrate the successful performance of a high-risk procedure from an unusual location.

WPW-1Fig. 1. Anteroseptal pathway – pre-ablation ECG.


WPW-2Fig. 2. Localisation of pathways.


WPW-3Fig. 3. Post ablation (DELTA lost).


WPW-4Fig. 4. Ablation spot in aortic CUSP (near right coronary artery – RCC).


WPW-5Fig. 5. Fused electrical signals at NCC – RCC site.

Parahisian pathways

  • Anteroseptal and midseptal pathway are close to AV node and Bundle of HIS
  • Ablating them directly can result in AV BLOCK.
  • Aortic cusp gives a vantage point to access these accessory pathways.
  • Our case is one example where we were very close to Right coronary but lucky to get rid of the pathway.

Dr. T. Joseph
Consultant Interventional Cardiologist & Electrophysiologist