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Sternick EB, Sanchez-Quintana D, Wellens HJJ, Anderson RH. Mahaim Revisited. Arrhythm Electrophysiol Rev 2022; 11:e14. [PMID: 35990105 PMCID: PMC9376831 DOI: 10.15420/aer.2022.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022] Open
Abstract
The name Ivan Mahaim is well-known to electrophysiologists. However, alternative anatomical substrates can produce the abnormal rhythms initially interpreted on the basis of the pathways he first described. These facts have prompted suggestions that Mahaim should be deprived of his eponym. It is agreed that specificity is required when describing the pathways that produce the disordered cardiac conduction, and that the identified pathways should now be described in an attitudinally appropriate fashion. The authors remain to be convinced that understanding will be enhanced simply by discarding the term ‘Mahaim physiology’ from the lexicon. It is fascinating to look back at the history of accessory atrioventricular junctional conduction pathways outside the normal accessory atrioventricular conduction system, and their possible role in rhythm disturbances. It took both the anatomist and the clinical arrhythmologist quite some time to understand the complex anatomical architecture and the ensuing electrophysiological properties. Over the years, the name Mahaim was often mentioned in those discussions, although these pathways were not the ones that produced the eponym. The reason for this review, therefore, is to present relevant information about the person and what followed thereafter.
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Affiliation(s)
| | | | | | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
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2
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Multiple QRS Morphologies. JACC Case Rep 2022; 4:610-612. [PMID: 35615216 PMCID: PMC9125518 DOI: 10.1016/j.jaccas.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
Regular wide complex tachycardia carries with it a standard array of differential diagnoses. This electrocardiogram demonstrates wide complex tachycardia and multiple QRS configurations in a neonate without structural heart disease with an uncommon suspected underlying diagnosis. (Level of Difficulty: Advanced.)
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Saviano M, Toriello F, Barbieri L, Carugo S. Ventricular ectopy following accessory pathway ablation in WPW syndrome. J Electrocardiol 2021; 69:119-123. [PMID: 34695778 DOI: 10.1016/j.jelectrocard.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/16/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Many Authors already described automatic activity arising from accessory pathways, but the underlying mechanism has not been clarified yet. They may be due to embryogenetic features of myocardium or may be related to specific excitability during radiofrequency ablation. CASE Our report shows that ventricular accelerated rhythm may transiently arise from the ventricular edge of a common myocardium made accessory pathway right after the ablation. No further action were required in our experience, since the phenomenon self extinguished in approximately hour. CONCLUSIONS If this manifestation represents the effect of thermal injury or if it is a real intrinsic automaticity is not fully documented and may need further reporting and investigation.
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Affiliation(s)
- Massimo Saviano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milano, Italy.
| | - Filippo Toriello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milano, Italy
| | - Lucia Barbieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milano, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milano, Italy
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Matta M, Marazzato J, De Ponti R, Gaita F, Anselmino M. Ablation of Accessory Pathways with Uncommon Electrophysiologic Properties. Card Electrophysiol Clin 2020; 12:567-581. [PMID: 33162004 DOI: 10.1016/j.ccep.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In rare cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic features that may be related to their specific anatomy. Most of these bundles show decremental nodelike conduction properties and sustain peculiar forms of arrhythmias that require careful differential diagnosis. On the other hand, some pathways do not actively sustain any reentrant circuit and should nevertheless be promptly recognized to avoid unnecessary ablation attempts. Although rare, these variants of accessory pathway should be known to warrant a safe and effective catheter ablation procedure.
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Affiliation(s)
- Mario Matta
- Cardiology Division, Sant'Andrea Hospital, corso Mario Abbiate, 21, Vercelli 13100, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fiorenzo Gaita
- Cardiology Unit, J Medical Via Druento, 153/56, Turin 10151, Italy
| | - Matteo Anselmino
- Cardiology Division, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Turin, Corso Bramante, 88, Turin 10126, Italy.
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Abstract
In some cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic properties related to their specific anatomy. Most of these fibers, which may be responsible for variants of ventricular preexcitation, show decremental conduction properties due to a nodelike aspect or a peculiar tortuous anatomic route across the atrioventricular groove. Moreover, some fibers do not actively sustain any reentrant circuit and can be only involved as bystander in other arrhythmias. Although rare, these accessory pathway variants should be properly diagnosed using noninvasive and invasive methods to guide catheter ablation procedures when needed.
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Arias MA, Pachón M, Martín-Sierra C. Spontaneous Wide QRS Complex Rhythm in a Patient With Wide QRS Complex Tachycardia. Circulation 2020; 141:1498-1503. [PMID: 32364776 DOI: 10.1161/circulationaha.120.046002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Miguel A Arias
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Spain
| | - Marta Pachón
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Spain
| | - Cristina Martín-Sierra
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Spain
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Soares Correa F, Lokhandwala Y, Cruz Filho F, Sánchez‐Quintana D, Mori S, Anderson RH, Wellens HJJ, Back Sternick E. Part II—Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways. J Cardiovasc Electrophysiol 2019; 30:3079-3096. [DOI: 10.1111/jce.14203] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/07/2019] [Accepted: 09/28/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Frederico Soares Correa
- Post Graduation DepartmentFaculdade de Ciências Médicas Belo Horizonte Brazil
- Arrhythmia and Electrophysiology DepartmentBiocor Institute Nova Lima Brazil
| | | | - Fernando Cruz Filho
- Centro de Tecnologia CelularInstituto Nacional de Cardiologia Rio de Janeiro Brazil
| | | | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of Medicine Kobe Japan
| | - Robert H. Anderson
- Institute of Genetic MedicineNewcastle University Newcastle upon Tyne United Kingdom
| | | | - Eduardo Back Sternick
- Post Graduation DepartmentFaculdade de Ciências Médicas Belo Horizonte Brazil
- Arrhythmia and Electrophysiology DepartmentBiocor Institute Nova Lima Brazil
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Arias MA, Pachón M, Puchol A, Martín-Sierra C. Spontaneous automaticity of a right atriofascicular accessory pathway. J Cardiovasc Electrophysiol 2019; 30:969-970. [PMID: 30884026 DOI: 10.1111/jce.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Miguel A Arias
- Department of Cardiology, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain
| | - Marta Pachón
- Department of Cardiology, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Department of Cardiology, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain
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Sternick EB, Lokhandwala Y, Wellens HJJ. An unusual ectopic ventricular rhythm in a young woman. J Cardiovasc Electrophysiol 2019; 30:1164-1167. [PMID: 30834649 DOI: 10.1111/jce.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 11/30/2022]
Abstract
A case of a 22-year-old young pregnant woman with palpitations and near syncope is presented. Holter monitoring showed very frequent premature beats and runs of wide complex tachycardia, refractory to antiarrhythmic drugs. Electrophysiologic evaluation disclosed spontaneous automatism arising in an atriofascicular pathway. Differential diagnosis is discussed.
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Affiliation(s)
- Eduardo B Sternick
- Electrophysiology Unit, Biocor Instituto, Nova Lima, Faculdade Ciências Médicas - MG, Belo Horizonte, Brazil
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de Alencar Neto JN, Ramalho de Moraes SR, Back Sternick E, Wellens HJJ. Atypical bypass tracts: can they be recognized during sinus rhythm? Europace 2018; 21:208-218. [DOI: 10.1093/europace/euy079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- José Nunes de Alencar Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Saulo Rodrigo Ramalho de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Eduardo Back Sternick
- Faculdade Ciências Médicas, Belo Horizonte, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte - MG, Brazil
- Arrhythmia Unit, Biocor Hospital, Alameda Oscar Niemeyer, 217 - Vila da Serra, Nova Lima - MG, Brazil
| | - Hein J J Wellens
- Cardiovascular Research Institute, Cardiovascular Research Institute, 6229 HX Maastricht, The Netherlands
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Mahaim pathway tachycardia versus bystander ventricular tachycardia: A distinction without a difference. HeartRhythm Case Rep 2018; 4:92-97. [PMID: 29707482 PMCID: PMC5918180 DOI: 10.1016/j.hrcr.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yang JD, Zhou GB, Sun Q, Guo XG, Liu X, Luo B, Wei HQ, Liang JJ, Xie S, Ouyang FF, Ma J. Electrocardiographic and electrophysiologic differentiation between atriofascicular, long atrioventricular, and short atrioventricular decrementally conducting accessory pathways. Europace 2017; 20:1666-1674. [PMID: 29244066 DOI: 10.1093/europace/eux354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jackson J Liang
- Department of Cardiology, Hospital of the University of Pennsylvania, Spruce Street, Founders 9, Philadelphia, PA 19104, USA
| | - Shuanglun Xie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fei-Fan Ouyang
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Abstract
Ebstein anomaly is a rare form of congenital heart disease with a uniquely high prevalence of arrhythmias. The most prevalent arrhythmia mechanisms are intrinsic to the underlying embryologic defects and may manifest at any stage. Current electrophysiological and surgical strategies are well equipped to address these arrhythmia mechanisms, yet despite available technology and a robust understanding of the mechanisms, these cases remain challenging. Surgical techniques that render arrhythmia substrates unreachable mandate comprehensive presurgical electrophysiological assessment and potential ablation. As the population ages, the need to address atrial fibrillation management and risk stratification for sudden cardiac death becomes ever more pertinent.
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Affiliation(s)
- Elizabeth D Sherwin
- Division of Cardiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Dominic J Abrams
- Division of Cardiac Electrophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Venier S, Khairy P, Thibault B, Rivard L. Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber. HeartRhythm Case Rep 2017; 2:379-383. [PMID: 28491715 PMCID: PMC5419942 DOI: 10.1016/j.hrcr.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sandrine Venier
- Electrophysiology Department of the Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Electrophysiology Department of the Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Electrophysiology Department of the Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Electrophysiology Department of the Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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JASTRZEBSKI MAREK, PITAK MACIEJ, RUDZINSKI ANDRZEJ, CZARNECKA DANUTA. Wide QRS Complex Tachycardia in a Patient With Concealed Accessory Pathway: What Is the Mechanism? J Cardiovasc Electrophysiol 2016; 27:1121-3. [DOI: 10.1111/jce.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- MAREK JASTRZEBSKI
- First Department of Cardiology; Interventional Electrocardiology and Hypertension; Cracow Poland
| | - MACIEJ PITAK
- Department of Cardiology, Institute of Pediatrics; Jagiellonian University Medical College; Cracow Poland
| | - ANDRZEJ RUDZINSKI
- Department of Cardiology, Institute of Pediatrics; Jagiellonian University Medical College; Cracow Poland
| | - DANUTA CZARNECKA
- First Department of Cardiology; Interventional Electrocardiology and Hypertension; Cracow Poland
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Successful ablation of incessant idiopathic right ventricular tachycardia arising from unusual sites in children. Cardiol Young 2016; 26:764-71. [PMID: 26165382 DOI: 10.1017/s1047951115001341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most idiopathic right ventricular tachycardias originate from the outflow tract. We present a case series of idiopathic incessant ventricular tachycardia arising from unusual sites of the right ventricle in children, which were well resolved by catheter ablation. METHODS A retrospective review was performed of all three patients who underwent ablation of idiopathic ventricular tachycardia below the level of the right ventricular outflow tract using three-dimensional mapping in our institute. Result All three patients presented with tachycardia-induced cardiomyopathy due to incessant ventricular tachycardia on first admission. The sites of successful ablation were at the proximal right bundle branch, distal right bundle branch, and apex of the right ventricle, respectively. No complications occurred, and there has been no recurrence of ventricular tachycardia after the final ablation at an average follow-up period of 9 months. All three patients have achieved normalisation of left ventricular size and systolic function. CONCLUSION Incessant idiopathic ventricular tachycardia originating from unusual sites of the right ventricle in children, resulting in significant symptoms and impaired ventricular function, can be successfully treated with catheter ablation.
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Chen M, Gu K, Yang B, Chen H, Ju W, Zhang F, Yang G, Li M, Lu X, Cao K, Ouyang F. Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia. Circ Arrhythm Electrophysiol 2014; 7:1159-67. [PMID: 25378469 DOI: 10.1161/circep.114.002112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accelerated idioventricular rhythm (AIVR) or ventricular tachycardia (VT) originating from the right bundle branch (RBB) is rare and published clinical data on such arrhythmia are scarce. In this study, we will describe the clinical manifestations, diagnosis, and management of a cohort of patients with this novel arrhythmia. METHODS AND RESULTS Eight patients (5 men; median age, 25 years) with RBB-AIVR/VT were consecutively enrolled in the study. Pharmacological testing, exercise treadmill testing, electrophysiological study, and catheter ablation were performed in the study patients, and ECG features were characterized. All RBB-AIVR/VTs were of typical left bundle-branch block morphology with atrioventricular dissociation. The arrhythmias, which demonstrated chronotropic variability, were often isorhythmic with sinus rhythm and were accelerated by physical exercise, stress, and intravenous isoprenaline infusion. The rate of RBB-AIVR/VT varied from 45 to 200 beats per minute. Two patients experienced syncope, and 3 had impaired left ventricular function. Metoprolol was proven to be the most effective drug to decelerate the arrhythmia rate and relieve symptoms. Electrophysiology study was performed in 5 patients and the earliest activation with a sharp RBB potential was localized in the mid or distal RBB area. Catheter ablation terminated the arrhythmia with subsequent RBB block morphology during sinus rhythm. During follow-up, patients' symptoms were controlled with normalization of left ventricular function either on metoprolol or by catheter ablation. CONCLUSIONS RBB-AIVR/VT is an unusual type of ventricular arrhythmia. It can result in significant symptoms and depressed ventricular function and can be successfully treated with catheter ablation.
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Affiliation(s)
- Minglong Chen
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.).
| | - Kai Gu
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Bing Yang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Hongwu Chen
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Weizhu Ju
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Fengxiang Zhang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Gang Yang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Mingfang Li
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Xinzheng Lu
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Kejiang Cao
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
| | - Feifan Ouyang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.C., K.G., B.Y., H.C., W.J., F.Z., G.Y., M.L., X.L., K.C.); and II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany (F.O.)
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ARIAS MIGUELA, PACHÓN MARTA, AKERSTRÖM FINN, JIMÉNEZ-LÓPEZ JESÚS. An Irregular Rhythm in a Patient with Ventricular Preexcitation: What Is The Mechanism? J Cardiovasc Electrophysiol 2014; 25:217-9. [DOI: 10.1111/jce.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- MIGUEL A. ARIAS
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
| | - MARTA PACHÓN
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
| | - FINN AKERSTRÖM
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
| | - JESÚS JIMÉNEZ-LÓPEZ
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
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Honarbakhsh S, Suman-Horduna I, Mantziari L, Ernst S. Successful Right Ventricular Tachycardia Ablation in a Patient with Left Ventricular Non-compaction Cardiomyopathy. Indian Pacing Electrophysiol J 2013; 13:181-4. [PMID: 24130428 PMCID: PMC3775322 DOI: 10.1016/s0972-6292(16)30671-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We report a case of a 67-year old male with a recent diagnosis of left ventricular non-compaction (LVNC), initially presenting with symptomatic ventricular ectopy and runs of non-sustained ventricular tachycardia (VT). This ventricular arrhythmia originated in a structurally normal right ventricle (RV) and was successfully localized and ablated with the aid of the three-dimensional mapping and remote magnetic navigation.
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WILLIAMS STEVENE, KOJODJOJO PIPIN, LINTON NICK, WRIGHT MATTHEW, O'NEILL MARKD. Ectopy and Supraventricular Tachycardia: Is There a Relationship? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:497-500. [DOI: 10.1111/pace.12056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 10/02/2012] [Accepted: 10/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
- STEVEN E. WILLIAMS
- Division of Imaging Sciences & Biomedical Engineering; King's College, London; UK
| | - PIPIN KOJODJOJO
- Department of Cardiology; National University Heart Center; Singapore
| | - NICK LINTON
- Division of Imaging Sciences & Biomedical Engineering; King's College, London; UK
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Normal and abnormal development of the cardiac conduction system; implications for conduction and rhythm disorders in the child and adult. Differentiation 2012; 84:131-48. [DOI: 10.1016/j.diff.2012.04.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 04/16/2012] [Indexed: 11/20/2022]
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22
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Mönnig G, Wasmer K, Milberg P, Schulz P, Köbe J, Zellerhoff S, Kochhäuser S, Pott C, Hindricks G, Borggrefe M, Breithardt G, Eckardt L. Predictors of long-term success after catheter ablation of atriofascicular accessory pathways. Heart Rhythm 2012; 9:704-8. [DOI: 10.1016/j.hrthm.2011.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Indexed: 11/27/2022]
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Sosa E, Scanavacca M. Incessant ventricular tachycardia due to spontaneous automaticity in the Purkinje network inducing reversible left ventricular dysfunction. Europace 2010; 13:292-4. [PMID: 20817939 DOI: 10.1093/europace/euq305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eduardo Sosa
- Heart Institute-InCor, São Paulo Medical School, São Paulo, Brazil.
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VERBEET THIERRY, CASTRO-RODRIGUEZ JOSÉ, MORISSENS MARIELLE, TRAN-NGOC EMMANUEL, PEPERSTRAETE BÉATRICE, TATNGA VALENTIN, CATEZ EMMANUEL, VIVIAN GABRIELAFLORES, DE BEEK VANESSAOP, MANDAG NATHALIENGO, ZAOUI NASSIME, DECOODT PIERRE, KNECHT SÉBASTIEN. Pre-excited or Not Pre-excited? Pacing Clin Electrophysiol 2009; 32:1203-6. [DOI: 10.1111/j.1540-8159.2009.02466.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee KW, Badhwar N, Scheinman MM. Supraventricular Tachycardia—Part II: History, Presentation, Mechanism, and Treatment. Curr Probl Cardiol 2008; 33:557-622. [DOI: 10.1016/j.cpcardiol.2008.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spontaneous automaticity arising from a successfully ablated Mahaim fiber. J Interv Card Electrophysiol 2007; 20:25-8. [PMID: 17943429 DOI: 10.1007/s10840-007-9164-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
Abstract
The authors describe a 22-year-old woman with regular and irregular arrhythmias exhibiting left bundle branch block (LBBB) morphology at various heart rates. An atriofascicular fiber was diagnosed as the underlying mechanism for the antidromic reciprocating tachycardia. In addition, spontaneous automaticity of the Mahaim fiber was present during electrophysiologic study. The accessory pathway was ablated successfully, targeting a Mahaim potential at the supero-anterior tricuspid valve annulus. Relatively slow automatic rhythms with identical LBBB morphology were recorded immediately after ablation, as well as during long-term follow-up in a more sporadic and subclinical form. Abnormal automaticity arising from the distal portions of the remnant pathway was considered to be the origin of the slow ventricular rhythms in this peculiar case.
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Traykov VB, Pap R, Bencsik G, Makai A, Sághy L. Transition of Narrow into Wide Complex Tachycardia with Left Bundle Branch Block Morphology and Varying QRS Duration: What is the Mechanism? Pacing Clin Electrophysiol 2007; 30:547-50. [PMID: 17437581 DOI: 10.1111/j.1540-8159.2007.00707.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morita N, Kobayashi Y, Katoh T, Takano T. Anatomic and electrophysiologic evaluation of a right lateral atrioventricular Mahaim fiber. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 28:1138-41. [PMID: 16221277 DOI: 10.1111/j.1540-8159.2005.00224.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a patient who underwent an electrophysiologic study and radiofrequency catheter ablation for a right lateral Mahaim fiber. During sinus rhythm with overt preexcitation, propagation mapping was performed in the right ventricle using a three-dimensional electro-anatomical mapping system (CARTO). Small discrete potentials, which reflected the excitation of the Mahaim fiber, could be recorded along the line from the vicinity of the parental tricuspid annulus to approximately one-third of distal site from the base to the apex. The relationship of the timing of its potential to the anatomical location could be disclosed on recordings of the local electrogram and anatomical map.
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Affiliation(s)
- Norishige Morita
- First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
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Abstract
The aim of this review article is to discuss the electrocardiographic presentation of the so called variants of pre-excitation ("Mahaim fibers") during sinus rhythm and tachycardia.
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Dora SK, Tharakan JA, Valaparambil A, Namboodiri N, Nair K, Peter T. Spontaneous automaticity of an atriofascicular accessory pathway. ACTA ACUST UNITED AC 2006; 8:140-3. [PMID: 16627427 DOI: 10.1093/europace/euj003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In a 12-year-old girl with history of recurrent palpitation, an ambulatory 24 h Holter electrocardiogram showed a wide QRS complex rhythm with atrioventricular dissociation. During an electrophysiology study, an atriofascicular pathway was diagnosed with an inducible antidromic atrioventricular re-entrant tachycardia. At slower heart rates, the patient had a wide QRS complex escape rhythm similar to the tachycardia and the pre-excited QRS complex morphology. This indicates the presence of pacemaker-like cells in the atriofascicular accessory pathway giving rise to the wide QRS complex escape rhythm at a slower heart rate.
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Affiliation(s)
- Santosh Kumar Dora
- Division of Cardiology Department of Medicine, Cedars-Sinai Medical Center, Los-Angeles, CA 90048, USA.
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Kojodjojo P, Kangaratnam P, Davies DW, Peters NS. Alternating R-R intervals during broad-complex tachycardia: what is the mechanism? J Cardiovasc Electrophysiol 2005; 16:1252-4. [PMID: 16302913 DOI: 10.1111/j.1540-8167.2005.50090.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pipin Kojodjojo
- St. Mary's Hospital, Imperial College of Medicine, London, UK.
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Sternick EB, Fagundes ML, Cruz FES, Timmermans C, Sosa EA, Rodriguez LM, Gerken LM, Scanavacca MI, Wellens HJJ. Short atrioventricular Mahaim fibers: observations on their clinical, electrocardiographic, and electrophysiologic profile. J Cardiovasc Electrophysiol 2005; 16:127-34. [PMID: 15720449 DOI: 10.1046/j.1540-8167.2004.40508.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Short A-V manheim fiber. INTRODUCTION A short atrioventricular decrementally conducting accessory pathway is an uncommon variant of preexcitation. Available data from small series suggest that their decremental properties might not be caused by A-V nodal-like tissue. METHODS We compared clinical, electrocardiographic and electrophysiologic parameters in two groups of patients: 8 patients with a short A-V Mahaim pathway (Group A), and 33 patients with atriofascicular pathways (Group B). Radiofrequency catheter ablation was carried out guided by activation mapping at the annulus in Group A patients and targeting the "M" potential in Group B patients. RESULTS After ablation of all associated rapidly conducting bypass tracts, 7 of the 8 Group A patients showed clear preexcitation. In only 1 of 8 patients the short A-V Mahaim fiber was actively engaged in a reentrant tachycardia circuit. During radiofrequency catheter ablation an automatic rhythm occurred in 4 of 8 patients. Intravenous adenosine caused conduction a block in the Mahaim fiber in 3 of the 5 patients tested. In group B, no patient showed clear preexcitation (P<00001) while 72% had a minimal preexcitation pattern. Twenty-nine of the 33 patients had a circus movement tachycardia with AV conduction over the atriofascicular fiber. During radiofrequency catheter ablation 30 of 33 patients showed accessory pathway automaticity. Adenosine caused transient block at the atriofascicular pathway in 11 (92%) of the 12 patients tested. CONCLUSIONS While short decrementally conducting right-sided accessory pathways show a typical ECG pattern different from atriofascicular pathways, their electrophysiologic properties do not seem to be uniform. Those pathways can be successfully interrupted by catheter ablation.
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Jongbloed MRM, Wijffels MCEF, Schalij MJ, Blom NA, Poelmann RE, van der Laarse A, Mentink MMT, Wang Z, Fishman GI, Gittenberger-de Groot AC. Development of the Right Ventricular Inflow Tract and Moderator Band. Circ Res 2005; 96:776-83. [PMID: 15761198 DOI: 10.1161/01.res.0000162000.03997.65] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atriofascicular accessory bundles with AV-node like conduction properties can sustain atrioventricular (AV) re-entrant tachycardia (Mahaim tachycardia). During early embryogenesis, the AV canal is situated above the primitive left ventricle (LV), and a right AV connection has not been achieved yet. We studied the formation of the right ventricular (RV) inflow tract in relation to the developing cardiac conduction system and hypothesized a morphological explanation for functional atriofascicular bypass tracts. Analysis of lacZ-expression during sequential stages of cardiogenesis was performed in CCS-lacZ transgenic mice (E9.5 to 15.5). Embryos were stained for β-galactosidase activity and the myocardial marker HHF35. At early stages CCS-lacZ expression was observed in a ring surrounding the AV canal, which connected at the inner curvature to the primary fold. The first sign of formation of the (CCS-lacZ negative) RV inlet component was a groove in the CCS-lacZ positive tissue of the primary fold. Outgrowth of the RV inlet tract resulted in division of the primary fold in a septal part, the trabecula septomarginalis and a lateral part, the moderator band, which extended laterally up to the right AV ring. Electrophysiological measurements in embryonic hearts (E15.5) in which the right atrium (RA) and RV were isolated from the left atrium (LA) and LV supported the functionality of this AV-connection via the moderator band, by demonstrating sequential atrial and ventricular activation in both RA/RV and LA/LV preparations. In conclusion, our observations may provide a possible morphological and functional explanation for atriofascicular accessory pathways via the moderator band, underlying Mahaim tachycardia.
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Affiliation(s)
- M R M Jongbloed
- Dept of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Ellenbogen KA, Vijayaraman P. Mahaim Fibers: New Electrophysiologic Insights into an Unusual Variant. J Cardiovasc Electrophysiol 2005; 16:135-6. [PMID: 15720450 DOI: 10.1046/j.1540-8167.2005.40702.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kenneth A Ellenbogen
- Division of Cardiology, Medical College of Virginia and McGuire VA Medical Center, Richmond, Virginia 23298-0053, USA.
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De Ponti R, Salerno-Uriarte JA. “Mahaim” fasciculoventricular fibers: Rare variant of ventricular preexcitation or subtle clinical problem? Heart Rhythm 2005; 2:7-9. [PMID: 15851256 DOI: 10.1016/j.hrthm.2004.10.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The case of an 8-year-old girl with incessant nonsustained left bundle branch block-like tachycardia refractory to antiarrhythmic drug therapy is reported. Electrophysiologic study revealed the presence of a right-sided accessory atriofascicular pathway. Episodes of nonsustained tachycardia were found to be based upon a dual response in AV conduction over the Mahaim fiber to one P wave. No reentrant tachycardia could be induced. The arrhythmia was cured by catheter ablation targeting a Mahaim potential at the right lateral tricuspid annulus. The findings can be explained by longitudinal dissociation in a single Mahaim fiber, a fiber distally diverging into two fibers with different conduction times, or (less likely) two closely located Mahaim fibers with different conduction times.
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Affiliation(s)
- Eduardo Back Sternick
- Department of Arrhythmia and Electrophysiology of BIOCOR Instituto, Nova Lima, Brazil.
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Sternick EB, Timmermans C, Rodriguez LM, Wellens HJJ. Mahaim fiber: An atriofascicular or a long atrioventricular pathway? Heart Rhythm 2004; 1:724-7. [PMID: 15851246 DOI: 10.1016/j.hrthm.2004.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Accepted: 07/18/2004] [Indexed: 10/26/2022]
Abstract
There is debate concerning the distal insertion of Mahaim fibers. Some findings favor an atriofascicular fiber connected with the distal right bundle branch. Other findings favor a long atrioventricular (AV) structure inserting into the myocardium. A patient having a decrementally conducting accessory pathway is reported. Proximal and distal Mahaim potentials were recorded during sinus rhythm, atrial pacing, and antidromic tachycardia. Both proximal and distal M potentials always preceded the QRS complex during sinus rhythm and antidromic tachycardia earlier than the right bundle branch potential. During tachycardia, the distal M potential was recorded 6 ms before the retrograde right bundle potential. Other arguments consistent with an AV connection were a change in the QRS configuration during tachycardia after the first radiofrequency pulse at the site of the distal M potential and absence of right bundle branch block after successful ablation. Conduction through the proximal part of the Mahaim fiber was unaltered after ablation, as assessed by recording the proximal M potential. Electrophysiologic evidence is presented suggesting a long AV accessory pathway inserting close to the distal right bundle branch rather than an atriofascicular connection in this patient with a Mahaim fiber.
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