Catheter ablation of an elusive accessory pathway in Ebstein's anomaly – Innovative surrogate for electroanatomic mapping

Abstract

Ebstein's anomaly accounts for < 1% of congenital heart diseases, the hallmark of which is the downward apical displacement of the tricuspid valve and cardinal albeit variable clinical symptoms of cyanosis, right-sided heart failure and arrhythmias.1,2 The typical echocardiographic feature of the disease is the apical displacement of the septal leaflet of tricuspid leaflet relative to the anterior mitral leaflet greater than 8.0 mm/m2.1 In Ebstein's anomaly manifest accessory pathways have been reported in 5–25% patients and half of these have multiple accessory pathways, mainly located on the right side. Paroxysmal atrioventricular reentrant tachycardia (AVRT) may occur in 25%–30% of patients on account of these manifest and additional concealed accessory pathways.3,4 We report a case of successful radiofrequency catheter ablation in a patient with Ebstein's anomaly who had earlier undergone two failed attempts.