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[Radiofrequency ablation of accessory pathway from noncoronary cusp of aorta after failed cryoablation].

Successful ablation of atrial or ventricular arrhythmia from aortic sinuses of Valsalva has been well documented with low complication rate. Radiofrequency (RF) ablation of anteroseptal pathway is always challenging for the risk of atrioventricular block. Thus cryoablation is widely accepted approach. We present a 27 year-old patient with WPW syndrome and frequent palpitations referred for cryoablation of anteroseptal pathway. Extensive mapping from high anterseptal region and from noncoronary aortic cusp of aorta revealed a sharp pathway potential but several applications of cryomapping were unsuccessful. Finally, the pathway was permanently ablated with RF energy from noncoronary cusp of aorta. The mapping of aortic valve should be performed during difficult anteroseptal pathway ablation and unsuccessful cryomapping dose not preclude successful RF ablation at the same location.