A case of catheter ablation of accessory atrioventricular connection between the right atrial appendage and right ventricle guided by a three-dimensional electroanatomic mapping system.

A 12-year-old girl was referred to our institution because of frequent episodes of AV reciprocating tachycardia. Ventriculoatrial and AV intervals were relatively long along the tricuspid annulus. Earliest retrograde atrial activation was recorded at the mid-portion of the right atrial appendage, 7 mm from the tricuspid annulus. The CARTO electroanatomic mapping system was very useful for providing accurate spatial orientation of the accessory connection. Complete ablation of this connection required multiple radiofrequency energy applications over an extensive area because of the multicomponent structure of the connection.