case_images: PMC11082373_01
case_images: (A) 12-lead ECG showing ventricular preexcitation with a negative delta wave in the right precordial leads. (B) 12-lead ECG after successful catheter ablation documenting loss of preexcitation (recorded at 25 mm/s).
case_images: fcvm-11-1392264-g001.jpg
case_images: PMC11082373_01_fcvm-11-1392264-g001.jpg
case_images: F1
case_images: ECG showed overt preexcitation with a positive delta wave in lead I and negative in leads V1-V3, suggesting a right free wall accessory pathway (Figure 1A). Application of pulsed field resulted in immediate interruption of accessory pathway conduction (Figure 1B).
case_images: (A) Local signals from the ablation catheter (ABLd and ABLp) at the site of the earliest ventricular activation during pacing in the right atrium (RA). Upper part shows surface ECG leads, lower part signals from the coronary sinus). (B) Electroanatomical activation map of the right atrium during right ventricular pacing, documenting the earliest activation remotely from the tricuspid annulus (red dots mark radiofrequency ablation cloud with the central tag removed to depict early activation). Inset depicts local electrogram at the tricuspid annulus during orthodromic AV reentry.
case_images: fcvm-11-1392264-g002.jpg
case_images: PMC11082373_01_fcvm-11-1392264-g002.jpg
case_images: F2
case_images: However, in the position of the earliest ventricular activation (-29 ms) during atrial pacing, the AV interval was not very short, and no electrograms of interest could be recorded (Figure 2A). During ventricular pacing, the earliest atrial activation was localized remotely from the tricuspid annulus (15 mm), suggesting true epicardial accessory pathway (Figure 2B).
case_images: (A) Radiogram in left anterior oblique projection, showing farawave catheter at the site of the earliest atrial activation during ventricular pacing, parallel to mapping catheter (MAP). Decapolar catheter is introduced in the coronary sinus (CS). Biomonitor is visible in lower part of the image. (B) Intracardiac echocardiogram depicting location of the Farawave catheter and its contact with the tissue at the ablation site (arrows). RA, right atrium; RAA, right atrial appendage.
case_images: fcvm-11-1392264-g003.jpg
case_images: PMC11082373_01_fcvm-11-1392264-g003.jpg
case_images: F3
case_images: The Farawave catheter (Boston Scientific, Inc) was used, and a flower configuration with the intention to cover the entire atrial attachment of the pathway was selected (Figures 3A,B).