What is the clinical evidence from this study?

Study design: Case Report. Population: Wolff-Parkinson-White syndrome (n=1). Intervention: Single-shot cryoablation. Primary outcome: Presence of delta wave on ECG and complaints/adverse health effects.

What does this research mean for the field?

Single-shot cryoablation can successfully eliminate the delta wave and symptoms in patients with Wolff-Parkinson-White syndrome who have complex coronary sinus anatomy and previous failed radiofrequency ablation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 17, 2020Open Access

Single-shot cryoablation of an epicardial inferoparaseptal accessory pathway: a case report

Key Result

Single-shot cryoablation successfully eliminated the delta wave and symptoms at 3 months in 1 patient with Wolff-Parkinson-White syndrome and complex coronary sinus anatomy.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 23-year-old man with Wolff-Parkinson-White syndrome, history of aborted sudden cardiac death, and unsuccessful previous radiofrequency ablation, followed for 3 months.

Intervention

Single-shot cryoablation of an epicardial inferoparaseptal accessory pathway

Outcome

Absence of delta wave on ECG and no complaints/adverse health effects

Single-shot cryoablation may be a viable alternative for epicardial accessory pathways when complex coronary sinus anatomy limits standard radiofrequency ablation.

Abstract

BACKGROUND: Catheter ablation (CA) of epicardial accessory pathways (APs) can be performed via the coronary sinus (CS) system. Variable CS anatomy with complications of former CA procedures inside the CS venous system may require using alternative CA approach and technology. CASE SUMMARY: We report the case of a 23-year-old man with Wolff-Parkinson-White syndrome and history of aborted sudden cardiac death (SCD) and unsuccessful previous AP radiofrequency ablation (RFA). CS venography during the redo procedure revealed an early CS trifurcation with cardiac veins stenosis, thus with difficulties in maintaining cardiac veins' access and catheter manoeuvring inside CS venous system. The last office visit with electrocardiogram (ECG) performance was in 3 months after the CA. Neither delta wave on the ECG nor any complaints/adverse health effects was detected at that time. DISCUSSION: Successful CA of epicardial AP in patients with a high risk of SCD is essential. However, CS complex anatomy and changes after former RFA inside it may lead to CS venous system access limitations. Alternative CA approach and technology should be considered to ensure CS venous system cannulation and epicardial AP CA performance.

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