Case Report (n=1)
This case vignette highlights a paradoxical response to para-Hisian pacing following ablation of a posteroseptal accessory pathway, prompting further mechanistic evaluation.
A patient underwent an electrophysiology study due to recurrent palpitations and pre-excitation on his resting electrocardiogram.The baseline electrocardiogram showed sinus rhythm with delta wave with negative to positive transition in V1 to V2 and negative delta wave in the inferior leads, suggestive of a posteroseptal manifest accessory pathway (AP).Radiofrequency was delivered on the posteroseptal region of the right atrium with abolition of pre-excitation.After ablation, para-Hisian pacing was performed with incremental pacing amplitude from the distal tip of a quadripolar catheter (Figure 1).What conclusions can be drawn from this pacing maneuvre?What is the most likely explanation for this observation?
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Portugal et al. (2026) conducted a case report in Recurrent palpitations and pre-excitation (n=1). Radiofrequency ablation was evaluated.
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