Key result
Percutaneous epicardial ablation successfully treated a concealed posteroseptal accessory pathway that spontaneously developed manifest pre-excitation.
Case Report (n=1)
Concealed accessory pathways can spontaneously transform into manifest pre-excitation (WPW syndrome), suggesting a need for ongoing surveillance in these patients.
May support epicardial access in refractory posteroseptal pathways; leaves open need for prospective validation.
Concealed accessory pathways (APs) are considered benign as they can only sustain orthodromic atrioventricular re-entrant tachycardia (ORT). We describe a unique case of a concealed posteroseptal AP where longitudinal surveillance following repeated failed ablation attempts due to abnormal coronary sinus (CS) anatomy revealed spontaneous development of manifest pre-excitation. The pathway was ultimately ablated via the percutaneous epicardial approach. The potential for development of Wolff-Parkinson-White (WPW) syndrome in patients with concealed APs has implications for ongoing surveillance in these patients.
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Lee et al. (2018) conducted a case report in Concealed posteroseptal accessory pathway (n=1). Percutaneous epicardial ablation was evaluated. Percutaneous epicardial ablation successfully treated a concealed posteroseptal accessory pathway that spontaneously developed manifest pre-excitation.
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