A 22 year old man with WPW syndrome and a structurally normal heart was admitted for the treatment of recurrent paroxysmal tachycardia. Induction protocols gave interesting clues for existence of more than one tachycardia mechanism. Five different tachycardia were demonstrated, the substrates being a right free wall accessory pathway (AP), a left lateral AP and dual AV nodal physiology. Successful ablation at 3 sites (lateral tricuspid annulus, lateral mitral annulus and slow pathway) in the same session led to complete elimination of these tachycardia mechanisms.
Key words: AVRT, His refractory, Outflow VT, Fascicular VT, Slow pathway.