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Keywords:

  • preexcitation syndrome;
  • radiofrequency catheter ablation;
  • accessory atrioventricular connection

Atrial and ventricular attachments of accessory atrioventricular connections have classically been localized to adjacent atrial and ventricular tissues, and this principle is responsible for the widespread success of radiofrequency catheter ablation. We present anatomical evidence of an unusually located accessory atrioventricular connection, which bridged the atrioventricular ring epicardially, directly from the base of the right atrial appendage to the right ventricle. This observation might offer a new insight into unusual accessory atrioventricular connection locations and may explain why some endocardial radiofrequency catheter ablation procedures might fail.