“Appearances can be deceptive” symptomatic Wolff–Parkinson–White syndrome in Ebstein’s anomaly

Ablation in Ebstein’s anomaly with Wolff–Parkinson–White (WPW) syndrome is very challenging due to complex anatomy and multiple arrhythmias associated with it. We expect atrioventricular reciprocating tachycardia which is the most common arrhythmia associated with WPW. As appearances can be deceptive, although in our case report, this 22-year-old female had preexcitation, she had typical atrial flutter, preexcited atrial fibrillation in addition to atrioventricular reciprocating tachycardia. She needed cavo-tricuspid isthmus ablation in addition to accessory pathway ablation to render the aforementioned arrhythmias noninducible. This case affirms the fact that a detailed and meticulous electrophysiologic study is to be done to diagnose all arrhythmias associated with this congenital heart disease.