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Kurath-Koller S, Sallmon H, Scherr D. Ventricular insertion site ablation of a Mahaim atriofascicular fibre in Ebstein anomaly. Cardiol Young 2024:1-2. [PMID: 38712631 DOI: 10.1017/s1047951124025083] [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] [Indexed: 05/08/2024]
Abstract
Ebstein anomaly is frequently associated with accessory pathways, including Mahaim atriofascicular fibres. We herein illustrate successful Mahaim fibre ablation in Ebstein anomaly by targeting the ventricular insertion site below the tricuspid ridge.
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Affiliation(s)
| | - Hannes Sallmon
- Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, Graz, Austria
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2
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Aymond J, Hoyt WJ, Thomas PE, Young T, Morin DP, Bernard ML. Open-window mapping of atriofascicular tachycardia. HeartRhythm Case Rep 2022; 8:776-780. [PMID: 36618597 PMCID: PMC9811027 DOI: 10.1016/j.hrcr.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Joshua Aymond
- Department of Cardiology, Ochsner Medical Center, New Orleans Louisiana
| | - Walter J. Hoyt
- Department of Pediatric Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Patricia E. Thomas
- Department of Pediatric Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Thomas Young
- Department of Pediatric Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Daniel P. Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans Louisiana
| | - Michael L. Bernard
- Department of Cardiology, Ochsner Medical Center, New Orleans Louisiana,Address reprint requests and correspondence: Dr Michael L. Bernard, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121.
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3
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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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Gormel S, Yasar S, Yildirim E, Asil S, Baris VO, Gokoglan Y, Celik M, Yuksel UC, Vurgun VK, Kabul HK, Kose S. Comprehensive assessment of Mahaim accessory pathways' anatomic distribution. J Int Med Res 2022; 50:3000605211069751. [PMID: 35001697 PMCID: PMC8753247 DOI: 10.1177/03000605211069751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To present the authors’ experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. Methods Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. Results Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12–66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). Conclusion MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.
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Affiliation(s)
- Suat Gormel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Salim Yasar
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Veysel Ozgur Baris
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Yalcın Gokoglan
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Murat Celik
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Uygar Cagdas Yuksel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | | | - Hasan Kutsi Kabul
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Sedat Kose
- Department of Cardiology, Liv Hospital, Ankara, Turkey
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5
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Van Praagh R. Tricuspid Valve Anomalies. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00013-5] [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: 11/29/2022]
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6
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He BJ, Merriman AF, Cakulev I, Stambler BS, Srivastava D, Scheinman MM. Ebstein's Anomaly: Review of Arrhythmia Types and Morphogenesis of the Anomaly. JACC Clin Electrophysiol 2021; 7:1198-1206. [PMID: 34454887 DOI: 10.1016/j.jacep.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Beixin Julie He
- Cardiology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA; Cardiology, Section of Cardiac Electrophysiology, University of Washington, Seattle, Washington, USA.
| | | | - Ivan Cakulev
- Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Deepak Srivastava
- Gladstone Institute of Cardiovascular Disease, San Francisco, California, USA; Department of Pediatrics, University of California-San Francisco, San Francisco, California, USA; Department of Biochemistry and Biophysics, University of California-San Francisco, San Francisco, California, USA
| | - Melvin M Scheinman
- Cardiology, Section of Cardiac Electrophysiology, University of California-San Francisco, San Francisco, California, USA
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7
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Kanzaki Y, Morishima I, Furui K, Yamauchi R. The spatial and temporal visualization of the entire atriofascicular fiber conduction during antidromic reciprocating tachycardia. HeartRhythm Case Rep 2021; 7:150-152. [PMID: 33786309 PMCID: PMC7987897 DOI: 10.1016/j.hrcr.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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8
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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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9
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Steinfurt J, Bode C, Faber TS. Mahaim pathway potential revealed by high-resolution three-dimensional mapping. Herzschrittmacherther Elektrophysiol 2020; 31:437-440. [PMID: 32989567 PMCID: PMC7683446 DOI: 10.1007/s00399-020-00721-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
Mapping and ablation of atriofascicular fibers can be highly challenging due to the complex and dynamic anatomy of the tricuspid valve annulus. This case highlights the utility of a multi-electrode catheter three-dimensional mapping approach to localize the Mahaim pathway along the tricuspid annulus in order to guide catheter ablation.
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Affiliation(s)
- Johannes Steinfurt
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Christoph Bode
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Thomas S Faber
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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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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11
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Lokhandwala Y, Vyas A. A Wide Complex Tachycardia in a Structurally Normal Heart: What is the Mechanism? Where to Ablate? J Innov Card Rhythm Manag 2019; 10:3504-3507. [PMID: 32494405 PMCID: PMC7252864 DOI: 10.19102/icrm.2019.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/26/2018] [Indexed: 11/26/2022] Open
Abstract
We present a case of wide complex tachycardia (left bundle branch block, superior axis) in a 30-year-old female with a structurally normal heart and no baseline preexcitation on electrocardiogram. Tachycardia initiation and atrial pacing confirmed the existence and participation of a right-sided atriofascicular decrementally conducting Mahaim pathway. Tachycardia mechanism validation by atrial pacing maneuvers was documented as well as was a response to adenosine and preexcited Mahaim atrial fibrillation. The usual ablation site did not record a Mahaim potential; hence, ablation was performed at a site other than the usual one.
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Affiliation(s)
- Yash Lokhandwala
- Cardiology Department, Holy Family Hospital and Research Center, Mumbai, India
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12
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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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13
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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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Philip Saul J, Kanter RJ, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, Cannon B, Clark J, Dick M, Freter A, Kertesz NJ, Kirsh JA, Kugler J, LaPage M, McGowan FX, Miyake CY, Nathan A, Papagiannis J, Paul T, Pflaumer A, Skanes AC, Stevenson WG, Von Bergen N, Zimmerman F. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 2016; 13:e251-89. [DOI: 10.1016/j.hrthm.2016.02.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 11/15/2022]
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Ozturk E, Ergul Y, Tanidir IC, Akdeniz C, Tola HT, Tuzcu V. Electroanatomic mapping guided cryoablation of Mahaim pathways in children with limited fluoroscopy exposure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:362-7. [PMID: 25546471 DOI: 10.1111/pace.12559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/01/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The presence of Mahaim accessory pathways (MAP) with anterograde decremental conduction is a disorder that leads to antidromic atrioventricular reentrant tachycardia. There are rare reports of cryoablation use in MAP. This study aims at sharing our experience with using cryoablation to treat MAP in children. METHODS Electrophysiology study and catheter ablation were performed in 14 patients diagnosed with Mahaim tachycardia between January 2010 and December 2013. Cryoablation was used in nine of the cases. A three-dimensional navigation system with surface electrode patches (EnSite System, St. Jude Medical Inc., St. Paul, MN, USA) was used for all procedures. RESULTS The patients (two girls and seven boys) had a median age of 11.5 years (8-18 years) and a median weight of 67 kg (31-80 kg). Mahaim conduction was localized in the right posterolateral (n = 4), right lateral region (n = 2), right posteroseptal (n = 1), right anterolateral (n = 1), and right anterior (n = 1). A pathway potential was noted in six of nine cases at the tricuspid annulus. Catheter choices and acute success rates were as follows: cryoablation in four (three of four successful), radiofrequency catheter ablation (RFA) and cryoablation in five (successful in four of five). No fluoroscopy was used in six of nine patients. The mean procedure duration was 249 ± 90 minutes. No major complications were observed. The final long-term success rate for cryoablation was seven of nine (78%). CONCLUSIONS Cryoablation can be used as a reliable and effective alternative to RFA in the treatment of Mahaim accessory conduction pathways in children. Prospective comparative studies are necessary in order to further evaluate the long-term efficacy of this method.
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Affiliation(s)
- Erkut Ozturk
- Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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16
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Ergul Y, Akdeniz C, Kiplapinar N, Tuzcu V. Successful cryoablation of Mahaim tachycardia in a child with Ebstein's anomaly. Pediatr Cardiol 2014; 34:1890-5. [PMID: 22806715 DOI: 10.1007/s00246-012-0434-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/03/2012] [Indexed: 11/25/2022]
Abstract
Mahaim fibers with decremental atrioventricular (AV) node-like conduction properties comprise less than 3 % of accessory pathways. Radiofrequency ablation of right atriofascicular pathways guided by a distinct Mahaim potential detected at the anterolateral to posterolateral tricuspid annulus or in the right ventricular free wall is a safe and highly effective treatment method. The case report presents a 16-year-old boy with Ebstein's anomaly and symptomatic wide complex tachyarrhythmia. The electrophysiologic study and the entire ablation procedure were performed using a three-dimensional mapping system (EnSite Velocity; St. Jude Medical Inc., St. Paul, MN, USA). No fluoroscopy was used during the procedure. Electrophysiologic evaluation demonstrated typical atrioventricular nodal reentrant tachycardia and Mahaim tachycardia with a wide QRS and a left bundle branch block pattern. After Mahaim potential was located at the lateral tricuspid annulus, successful cryoablation was performed with an 8-mm-tip catheter followed by slow pathway ablation to eliminate typical atrioventricular nodal reentrant tachycardia. Cryoablation with an 8-mm-tip catheter can be an alternative treatment option for children with Mahaim tachycardia.
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Affiliation(s)
- Yakup Ergul
- Pediatric Cardiology/Electrophysiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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Sternick EB, Lokhandwala Y, Bohora S, Timmermans C, Martins PR, Dias LV, Correia FS, Wellens HJJ. Is the 12-lead electrocardiogram during antidromic circus movement tachycardia helpful in predicting the ablation site in atriofascicular pathways? Europace 2014; 16:1610-8. [PMID: 24681762 DOI: 10.1093/europace/euu059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Unlike in the Wolff-Parkinson-White syndrome, there has been no systematic study on the role of the pre-excitation pattern in predicting the ablation site in patients with atriofascicular (AF) pathways. We assessed in a large cohort the value of the 12-lead electrocardiogram (ECG) during antidromic tachycardia (ADT) to predict the site of ablation. METHODS AND RESULTS Forty-five patients were studied, 23 males (51%), mean age of 27 ± 12 years with 46 AF pathways and 48 ADT using the AF pathway for A-V conduction. Inclusion required induction of a sustained ADT and successful ablation. Ablation site was assessed during LAO 45° projection and clockwise classified as hours in posteroseptal, posterolateral, lateral, anterolateral, and anteroseptal tricuspid annulus as follows: 05:00-07:00, >07:00-08:00, >08:00-09:00, >09:00-11:00, and >11:00-13:00 o'clock. The QRS axis was assessed during ADT and classified as normal (>+15°), horizontal (+15° to -30°), and superior (<-30°). During ADT axis was superior (-57° ± 10°) in 15 (31%), horizontal (-11° ± 14°) in 22 (46%), and normal (+45° ± 16°) in 11 (23%) patients. The correct ablation site did not differ between the different groups of QRS axis. QRS width during ADT was narrower in patients with a normal when compared with a horizontal and leftward axis (127 ± 14 vs. 145 ± 12 ms, P < 0.0001), and the V-H interval was shorter (4 ± 3 ms vs. 19 ± 22 ms, P = 0.03). CONCLUSIONS There was no correlation between the AF pathway ablation site and the QRS axis during ADT. The 12-lead ECG during maximal pre-excitation does not predict the proper site of tricuspid annulus ablation in patients with A-V conduction over an AF pathway.
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Affiliation(s)
- Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil Instituto de Pós Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | - Shomu Bohora
- UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | | | | | - Liana Valadão Dias
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil
| | | | - Hein J J Wellens
- CARIM-Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Thakur Y, Jones DL, Skanes A, Yee R, Drangova M. Right-side RF ablation using remote catheter navigation: experimental results in vivo. J Cardiovasc Electrophysiol 2011; 23:81-7. [PMID: 21806702 DOI: 10.1111/j.1540-8167.2011.02142.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The close proximity between the interventionalist and patient during catheter-based interventions for cardiac arrhythmia exposes the interventionalist to harmful radiation. A prototype remote catheter navigation system (RCNS) has been developed to reduce occupational dose. The safety, feasibility of this RCNS and a comparison of remote and conventional navigation techniques is investigated in vivo. METHODS Seven anatomical locations in the right side of the heart in porcine models were chosen as navigation targets. Using fluoroscopy and electrogram analysis, an experienced electrophysiology interventionalist manipulated a radiofrequency (RF) ablation catheter to each target using the RCNS and conventional navigation. Success rate, navigation time, exposure, exposure time and procedure time was recorded for all anatomical targets. Time to integrate the RCNS with the procedure suite was also measured. RESULTS All targets were successfully reached with the RCNS and conventional navigation. No erratic catheter motion was observed with the RCNS whereas 1 operation failure occurred. The anatomical targets were found to have the largest effect on navigation time (P < 0.05), exposure (P < 0.05), and exposure time (P < 0.01), although the navigation method had little to no effect on the metrics. These results suggest that remote navigation procedures can be performed with navigation times comparable to conventional bedside navigation. CONCLUSION Remote navigation with the RCNS may present a safe method of reducing occupational dose, while providing comparable navigation time with conventional bedside navigation.
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Affiliation(s)
- Yogesh Thakur
- Graduate Program in Biomedical Engineering, Robarts Research Institute, London, Ontario, Canada.
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19
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Ueda AT, Sakurada H, Nishizaki M, Hiraoka M. Catheter ablation of ventricular insertion of Mahaim fiber using noncontact mapping system in a patient with mirror-image dextrocardia. Pacing Clin Electrophysiol 2010; 33:e102-5. [PMID: 20230466 DOI: 10.1111/j.1540-8159.2010.02720.x] [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] [Indexed: 11/30/2022]
Abstract
We report a case of mirror-image dextrocardia with antidromic atrioventricular reciprocating tachycardia via the Mahaim fiber. Using the noncontact mapping system, arborized ventricular insertion of the Mahaim fiber was identified and successfully ablated.
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Affiliation(s)
- Akiko T Ueda
- Division of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
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Ablating the ventricular insertion of atrio-fascicular Mahaim fiber: what selection criteria should we use? J Interv Card Electrophysiol 2009; 25:207-11. [PMID: 19263202 DOI: 10.1007/s10840-008-9361-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
Abstract
We reported a patient who underwent RF ablation of the distal insertion of an atrio-fascicular accessory pathway with decremental properties because of inability to map a suitable potential alongside the tricuspid annulus. Small, discrete potentials resembling those of purkinje fiber were found at right ventricular apex, all these potentials showed early activation during tachycardia preceding the QRS onset of various degrees. Pace mapping helped to localize the presumed main distal insertion of the atrio-fascicular AP in a region where a damage of the His-purkinje system may ensue. This case report describes catheter ablation of an atriofascicular accessory pathway by targeting its distal (ventricular) insertion site.
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