Introduction: Preexcitation syndrome has a reported incidence of 0.1-0.3% in general population. Although many types of arrhythmias can occur in a patient with WPW syndrome, the most frequent causes of palpita-tions are orthodromic reentrant tachycardia and atrial fibrilation, rarely premature ventricular contractions. There are no cases previously described in the literature in which was performed in the same session the ablation of the accessory pathway and of sites of ventricular activation. Three-dimensional mapping system has an extremely important role in identifying the appropriate ablation sites.
Case presentation: We present the case of a 60-year-old man, recently diagnosed with ventricular preexci-tation, with multiple presentations in the emergency department for recurrent episodes of palpitations and who was also diagnosed with premature ventricular contractions with a moderate to high ectopic burden. After a first session of radiofrecquency ablation of the accessory pathway using conventional mapping system, with recurrence of the accessory pathway, a second catheter ablation with three-dimensional ma-pping system was performed at this level, and addi-tionally, the ablation of two septal sites of ventricular activation with origin possibly in postmyocarditis scar. After 6 months of follow-up the patient was asympto-matic, with disappearance of the arrhythmias and im-provement of left ventricular contractile function.
Case particularity: The relatively late diagnosis of the preexcitation syndrome and the catheter ablation in a single session of both the accessory pathway and two sites of ventricular activation identified at the postero-septal left ventricle, made our case particular.
Conclusion: Acute and long-term procedural success is possible even in complex arrhythmias and leads to a favourable long-term outcome.