Rare left-sided accessory pathway successfully ablated with atrial insertion site at the left-side fossa ovalis.

ABSTRACT

INTRODUCTION: Left-sided accessory pathway (AP) with atrial insertion away from the annulus is an atypical variation. Conventional mapping and ablation performed along mitral annulus (MA) is usually ineffective. METHODS: A 14-year-old girl without structural heart disease presented with recurrent episodes of sudden onset palpitations and electrocardiogram (ECG) showed a narrow QRS complex tachycardia. RESULTS: Electrophysiology study (EPS) was done and anterograde atrioventricular reentrant tachycardia (AVRT) with AP was diagnosed. Conventional mapping and ablation performed along TA and MA was failed. 3D-activation mapping found the retrograde atrial insertion site of AP on the left atrium fossa ovalis (FO), and AP was successfully abolished by radiofrequency ablation at that site. CONCLUSION: As reported, this patient is the first report of ablating a left-sided AP with retrograde atrial insertion on the left atrium FO.