Mitral Stenosis with WPW Syndrome

Abstract

The catheter ablation of accessory pathways in patient with underlying structural heart disease is essential and it can provide permanent cure. A 32 year farmer with WPW type A with recurrent supraventricular tachycardia with severe rheumatic mitral stenosis was investigated. Firstly, PTMC (Percutaneous Trans-catheter Mitral Commissurotomy) was performed successfully in this patient improving mitral valve area from 1.1 cm2 to 2.29 cm2 with 10 mmHg dropped in invasive mean left atrial and pulmonary pressure. After PTMC, basic EP (Electrophysiology) study with 4 catheters at coronary sinus (CS), right ventricular and atrium, and His was carried out. The earliest ventricular activation at sinus rhythm and atrial activation with ventricular pacing were observed both at CS-1 position. The inducible tachycardia was consistent with AVRT (Atrio-Ventricular Reentrant Tachycardia) involving the left lateral free wall accessory pathway. Mapping was performed around the CS-1 below the mitral valve with retrograde aortic approach. Radiofrequency energy was applied where ventricular activation was earlier than delta wave in surface ECG and retrograde atrial activation was earlier than CS 1 with ventricular pacing. The delta wave was disappeared and ventriculo-atrial dissociation was observed with ventricular pacing immediately after ablation indicating the successful ablation of left lateral free wall accessory pathway. Conclusively, successful radiofrequency ablation of accessory pathway in patients with structural heart disease is valuable and PTMC is a treatment option in selected cases of mitral stenosis.