Catheter ablation of an accessory pathway within the marshall vein in a patient with mechanical mitral valve.

A 37-year-old man, known case of mitral valve replacement, was referred for ablation. Meticulous mapping showed the earliest signal in the distal coronary sinus (CS). Endocardial ablation via transseptal approach failed to permanently ablate the accessory pathway. Similarly, ablation within the CS was unsuccessful. Finally, the mapping catheter was introduced into the vein of Marshall (VoM) and a very early signal was obtained. In the first 3 seconds of the radiofrequency energy application within the VoM, delta wave disappeared. During 1-year follow-up, the patient had no recurrence of the palpitations and electrocardiogram showed no delta wave.