Lehigh Valley Procedure: Combined Pulmonary Vein Isolation and Accessory Pathway Ablation for Atrial Fibrillation in Wolff-Parkinson-White Syndrome.

Wolff-Parkinson-White (WPW) syndrome is a congenital condition characterized by the presence of an accessory pathway (AP) that can lead to tachyarrhythmias such as atrial fibrillation (AF). Patients with WPW are at an increased risk of developing AF, with a prevalence of up to 30%. Despite successful ablation of the AP, AF recurrence remains a challenge, particularly in older patients or those with a history of AF. Concomitant pulmonary vein isolation (PVI) may help reduce the risk of recurrence by targeting atrial remodeling and pulmonary vein involvement in AF. This case describes a 70-year-old male with WPW and AF who underwent a combined PVI and AP ablation procedure. The patient remained free of AF post-procedure, suggesting that this approach may be effective in high-risk patients. Further randomized controlled trials are necessary to evaluate the efficacy of this combined approach in reducing AF recurrence compared to AP ablation alone, especially in older patients.