Successful radiofrequency catheter ablation of an accessory pathway in the right free wall using combination a long vascular sheet and a mapping catheter in the right coronary artery

We present a patient with an accessory pathway difficult to ablate in the right free wall. Two prolonged and failed attempts at radiofrequency catheter ablation of this accessory pathway in other institutions led to a third attempt in our hospital. Successful outcome of accessory pathway ablation was achieved by mapping the right free wall using an intracoronary catheter in the right coronary artery. A long vascular sheeth was introduced in the right femoral vein, manipulated into the tricuspid anulus, which allowed a stable catheter position with adequate tissue contact of the ablation catheter at the target site. The combination of exact mapping and adequate tissue contact of the ablation catheter as described above facilitated successful outcome in this patient. Further investigation is necessary to determine the role of this technique as first choice therapy in patients prone to develop recurrence of accessory pathway conduction or primary failure of catheter ablation.