Catheter ablation of a right posterior accessory pathway in a patient with left ventricular noncompaction

Figures

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  Figure 1. Twelve-lead electrocardiogram at baseline shows a short PR interval of 80 ms and negative delta waves in lead II, III, aVF, andV1, consistent with a right posterior accessory pathway. PR interval = interval between the P wave and th QRS complex.

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  Figure 2. Two-dimensional echocardiography showing a dilated left ventricle with low ejection fraction and trabeculations separated by recesses of the anterior, septal, and lateral LV walls. LV = left ventricle.

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  Figure 3. Cardiac magnetic resonance imaging (A–C) and computer tomography (D–F) short axis and longitudinal axis images showing trabeculations of the anterior, lateral and septal LV walls; the thickness of the noncompacted layer is 17 mm, while the thicnkess of the compacted layer is 7 mm, yielding a ratio between layers of 2.4; there is no visible thrombus in the LV. LV = left ventricle,

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  Figure 4. The electrophysiological study yields a negative −20 ms HV interval, consistent with the presence of an accessory pathway with short refractory period (<230 ms). HV = his-ventricular interval.

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  Figure 5. Catheter mapping at the level of the tricuspid annulus identified as pot where the atrial electrogram was fused with the ventricular electrogram. Catheter ablation at this level abolished the conduction through the accessory pathway.

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  Figure 6. Twelve-lead ECG after catheter ablation shows normal PR interval with absent delta wave. Negative T waves in the inferior leads suggest T-wave memory after successful catheter ablation of the accessory pathway.