Cryoablation and Angiographic Evidence of a Concealed Right Atrial Appendage to Right Ventricle Accessory Pathway in an Infant

We report a case of successful cryoablation of a concealed accessory pathway from the right atrial appendage to the right ventricle in an infant. A 4-month-old female who had previously undergone successful ablation of a left-sided accessory pathway was taken to the electrophysiology lab due to recurrent supraventricular tachycardia. While in this second supraventricular tachycardia, we found earliest atrial activation in the distal right atrial appendage. Angiography confirmed a connection between right atrial appendage and the right ventricle. Cryoablation at this location promptly terminated the supraventricular tachycardia. Following ablation, there were no further inducible arrhythmias and ventriculo-atrial dissociation was appreciated.