Accessory pathway ablation: When the going gets tough, the tough go epicardial

A 38-year-old lady presented with recurrent episodes of palpitations since the last four years. The electrocardiogram (ECG) during tachycardia indicated pre-excited atrial fibrillation, while the baseline ECG revealed preexcitation with QS waves in the inferior leads. Initial attempts at endocardial ablation and ablation via the coronary sinus approach did not yield successful results. Subsequently, we successfully ablated the inferoparaseptal (posteroseptal) pathway by utilizing a percutaneous epicardial approach. This method should be considered in cases where other techniques fail.