[Double fulguration of the bundles of His and Kent for recurrent tachycardia in Wolff-Parkinson-White syndrome].

A 59 year old patient with a left postero-septal Kent bundle had daily attacks of reciprocating tachycardia resistant to anti-arrhythmic therapy and was referred for catheter ablation. Kent bundle activity was recorded in the proximal part of the coronary sinus. An endocavitary electric shock delivered at this site suppressed conduction through the Kent bundle for several minutes. Catheter ablation of the His bundle (2 X 200 joules) was then attempted suppressing anterograde conduction for 2 days, after which conduction was reestablished and the reciprocating tachycardia recurred. A second session of catheter ablation was carried out and 2 X 200 joules shocks were delivered in the coronary sinus and 4 to the Bundle of His. Complete anterograde and retrograde atrioventricular block was obtained. Two weeks later, the patient recovered anterograde conduction through the accessory pathway. Retrograde conduction through the Kent bundle was decremental, RP' lengthening with increasing heart rate. Conduction was detected in the His bundle but was insufficient to give rise to reciprocating rhythm. After one year's follow-up the patient was asymptomatic without treatment. Catheter ablation of physiological or accessory conduction pathways provides a valuable alternative to surgical treatment of pre-excitation pathways in the WPW syndrome resistant to medical therapy.