What question did this study set out to answer?

To evaluate the effectiveness of epicardial ablation for patients with accessory pathways when other methods fail.

January 10, 2026Indian Pacing and Electrophysiology Journal0 citationsOpen Access

Accessory pathway ablation: When the going gets tough, the tough go epicardial

YKYogesh Jagannath KulkarniChristian Medical College, Vellore SSSirish Chandra SrinathChristian Medical College, Vellore AMAnand ManickavasagamChristian Medical College, Vellore

Key Points

To evaluate the effectiveness of epicardial ablation for patients with accessory pathways when other methods fail.
Observational study design

Structured PICO

Does percutaneous epicardial ablation successfully treat an inferoparaseptal accessory pathway when endocardial approaches fail?

Population

A 38-year-old female with recurrent palpitations, pre-excited atrial fibrillation, and an inferoparaseptal (posteroseptal) accessory pathway.

Intervention

Percutaneous epicardial ablation

Comparator

Initial attempts at endocardial ablation and ablation via the coronary sinus approach

Outcome

Successful ablation of the accessory pathway

Percutaneous epicardial ablation is a viable and effective alternative for accessory pathways when standard endocardial and coronary sinus approaches fail.

Abstract

A 38-year-old lady presented with recurrent episodes of palpitations since the last four years. The electrocardiogram (ECG) during tachycardia indicated pre-excited atrial fibrillation, while the baseline ECG revealed preexcitation with QS waves in the inferior leads. Initial attempts at endocardial ablation and ablation via the coronary sinus approach did not yield successful results. Subsequently, we successfully ablated the inferoparaseptal (posteroseptal) pathway by utilizing a percutaneous epicardial approach. This method should be considered in cases where other techniques fail.

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