ArticleFrontiers in cardiovascular medicine2026
Case Report: Pulsed field ablation of an oblique inferoparaseptal accessory pathway.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Radiofrequency ablation (RFA) remains the gold standard for Wolff-Parkinson-White (WPW) syndrome with ∼94% acute success, ∼6% recurrence. Pulsed field ablation (PFA) shows promise for complex accessory pathways (APs) but lacks data on oblique courses. Case presentation: A 36-year-old endurance athlete presented with incidental right paraseptal pre-excitation before methylphenidate initiation. He reported self-terminating palpitations (∼200 bpm) during moderate cycling. Electrophysiological study revealed an oblique inferoparaseptal AP with right atrial insertion (inferior interatrial septum/CS roof, Kent potential) and left inferoparaseptal ventricular exit (earliest retrograde activation mid-CS 5/6). Due to right coronary artery proximity, focal PFA via Centauri™ system (Galvanize) achieved complete CS ostium/roof block. Post-procedure ventricular pacing showed retrograde decremental conduction. At 3 months, he reported no tachycardias/palpitations. Discussion/conclusion: This case demonstrates focal PFA's feasibility for an underrepresented oblique inferoparaseptal AP amid complex CS/CSMC anatomy, avoiding RFA's coronary injury risk. While early PFA series report >99% acute success, randomized long-term data vs. RFA are needed. PFA represents a promising investigational approach for anatomically challenging APs.
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