| Summary: | Introduction. Anteroseptal accessory pathways (APs) are located in the apex
of the triangle of Koch’s connecting the atrial and ventricular septum in the
region of the His bundle. Ablation of anteroseptal pathway locations remains
a challenge to the electrophysiologist due to a very high risk of transiet or
permanent atrioventricular (AV) block. Case report. A male, 18-year-old,
patient was hospitalized due to radiofrequency (RF) ablation of APs. He was
an active football player with frequent palpitations during efforts
accompanied by dyspnea and lightheadedness, but without syncope.
Electrocardiography on admission showed intermittent preexcitations.
Intracardiac mapping showed the earliest ventricular activation that preceded
surface electrocardiographic delta wave in anteroseptal region very close to
the AV node and His bundle. Using a long vascular sheath for stabilization of
the catheter tip, RF energy was delivered at the target site starting at very
low energy levels and because of the absence of either PR prolongation, as
well as accelerated junctional rhythm during the first 15 sec, the power was
gradually increased to 40W, so after application RF energy preexcitation was
not registered. Conclusion. Despite this proximity to the His bundle and very
high risk of transiet or permanent AV block anteroseptal APs can still be
ablated successfully.
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