Anatomical Challenges During Left-Sided Accessory Pathway Ablation in a Patient With Pectus Carinatum.

In a patient presenting with Wolff-Parkinson-White syndrome and pectus carinatum, cardiac rotation rendered conventional RAO and LAO views unreliable during left-sided accessory pathway ablation. Customized fluoroscopic views with caudal angulation allowed for successful ablation, supporting pre-procedural CT imaging to plan for patient specific fluoroscopic angles.