Why the study?
Inability to ablate left accessory pathways from endocardial approaches may suggest an epicardial location.
Epicardial ablation via the great cardiac vein can be a successful strategy for left accessory pathways when endocardial approaches fail.
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Consider epicardial APs in outflow tract-like tachycardias; leaves open optimal ablation strategies for decrementally conducting pathways.
The inability to ablate left accessory pathways (APs) from endocardial approaches may suggest an epicardial location. We report on a 43-year-old woman presenting with a wide QRS tachycardia with Right Bundle Branch Block (RBBB) morphology, right inferior axis, and the "pattern break" appearance in V2 resembled the outflow tract ventricular tachycardia. An electrophysiology study confirmed an antidromic atrioventricular reentrant tachycardia using an antegrade slow, decrementally conducting AP that was successfully ablated in the great cardiac vein-anterior interventricular vein junction after failure of endocardial approach.
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Emkanjoo et al. (2020) studied this question.
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