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Kakarla S, Abhilash SP, Namboodiri N. Bump termination of an atriofascicular tachycardia. Where is the level of block? J Arrhythm 2024; 40:154-155. [PMID: 38333382 PMCID: PMC10848571 DOI: 10.1002/joa3.12969] [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: 10/09/2023] [Revised: 11/04/2023] [Accepted: 11/19/2023] [Indexed: 02/10/2024] Open
Abstract
This electrophysiological tracing localizes the level of block distal to the recorded Mahaim potential during bump termination mapping of an atriofascicular pathway at the tricuspid annulus.
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Affiliation(s)
- Saikiran Kakarla
- Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Sreevilasam P. Abhilash
- Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Narayanan Namboodiri
- Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
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2
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Chen M, Wang Z, Wang S, Liu Z, Li X, Yang H, Hu L, Wu Z, Li Q, Zhou S. Electrophysiological characteristics of right- and left-sided Mahaim accessory pathways: A single-center experience in China. Front Cardiovasc Med 2022; 9:1052465. [PMID: 36568537 PMCID: PMC9768021 DOI: 10.3389/fcvm.2022.1052465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Background Mahaim-type accessory pathways (MAPs) are rare accessory pathways (APs) with specific properties. They are mostly located in the right side of the heart but rarely exist on the left side. Objectives This study aims to analyze the clinical and electrophysiological (EP) characteristics of both-sided MAPs. Methods A total of 2,249 patients with AP from our center were enrolled between 1 January 2011 and 27 March 2022. During the EP study (EPS) 17 patients were diagnosed with MAPs (right-sided: n = 13, left-sided: n = 4) according to the properties of Mahaim fibers. Results MAPs constitute 0.75% of all APs. Out of 1,553 patients with left-sided APs, four patients (0.26%) were diagnosed with Mahaim fiber-mediated tachycardia. Out of 696 patients with right-sided APs, 13 patients (1.9%) were diagnosed with Mahaim fiber. Most Mahaim fibers were located at the free wall of the tricuspid and mitral annuli. Seven patients of right-sided MAPs were of atriofasicular type, six patients had right-sided MAPs, and all of the patients with left-sided MAPs were of atrioventricular (AV) type. The M potential only was detected in long-length MAPs. Coexistence with other supraventricular tachycardias (SVTs) was also observed both in patients with right-sided and left-sided MAPs. All the patients underwent radiofrequency ablation successfully. Only one patient had tachycardia recurrence during a follow-up. Conclusion Although MAPs are commonly located at right sides, left sites are not impossible. The M potential contributes to the improvement of the successful ablation.
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Affiliation(s)
- Mingxian Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhuo Wang
- Department of Cardiology, Wuhan Renmin Hospital of Wuhan University, Wuhan, China
| | - Songyun Wang
- Department of Cardiology, Wuhan Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenjiang Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xuping Li
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Yang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin Hu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhihong Wu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China,*Correspondence: Zhihong Wu
| | - Qiming Li
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shenghua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
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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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4
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Ozcan EE, Turan OE, Akdemir B, Inevi UD, Yilancioglu RY, Baskurt AA, Alak C, Bayrak F. Comparison of electrophysiological characteristics of right- and left-sided Mahaim-type accessory pathways. J Cardiovasc Electrophysiol 2021; 32:360-369. [PMID: 33355963 DOI: 10.1111/jce.14852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 12/01/2022]
Abstract
AIMS Mahaim-type accessory pathways (MAPs) are generally right-sided due to the embryological differentiation, but left-sided localization is also possible. This study aims to compare the clinical and electrophysiological characteristics of right- and left-sided MAPs. METHODS Of 251 patients diagnosed with AP by electrophysiological study between November 2015 and February 2020, 12 patients with MAP were included (right sided n = 8, left sided n = 4). MAP was diagnosed if; (1) no retrograde conduction; (2) anterograde decremental conduction; (3) adenosine sensitivity; and (4) Mahaim potential at successful ablation site were present. RESULTS Ten of twelve MAPs were clustered on the lateral walls of the mitral (n = 3, 75%) and tricuspid annuli (n = 7, 87.5%). Right-sided MAPs were mostly long pathways extending toward the conduction system whereas left-sided MAPs were short extending toward the neighboring myocardium. For right- and left-sided APs, the median QRS times were 129 and 156 ms (p = .042), the median VAbl -RVApex intervals were -12 and 64 ms (p = .007), the median QRS-V(His) intervals were 16 and 86 ms (p = .120), and the median VAbl -QRS interval was -8 and 12 ms (p = .017), respectively. Coexistence of dual atrioventricular node physiology was observed only in right-sided APs (n = 3, 37.5%). CONCLUSION MAPs are more typically located on the right but may rarely be seen on the left. Catheter ablation was associated with high success without complications.
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Affiliation(s)
- Emin Evren Ozcan
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Oguzhan Ekrem Turan
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Baris Akdemir
- Department of Cardiology, Faculty of Medicine, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | | | | | - Ahmet Anil Baskurt
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Cetin Alak
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Fatih Bayrak
- Department of Cardiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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5
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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: 0.2] [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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6
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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: 1.6] [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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7
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Lugenbiel P, Xynogalos P, Schweizer P, Katus HA, Thomas D, Scholz EP. Successful localization and ablation of a Mahaim potential using a high-resolution mapping catheter after a failed conventional ablation attempt. Clin Res Cardiol 2018. [PMID: 29532157 DOI: 10.1007/s00392-018-1231-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Patrick Lugenbiel
- Heidelberg Center for Heart Rhythm Disorders (HCR) & Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Panagiotis Xynogalos
- Heidelberg Center for Heart Rhythm Disorders (HCR) & Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Patrick Schweizer
- Heidelberg Center for Heart Rhythm Disorders (HCR) & Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Heidelberg Center for Heart Rhythm Disorders (HCR) & Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Heidelberg Center for Heart Rhythm Disorders (HCR) & Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Eberhard P Scholz
- Heidelberg Center for Heart Rhythm Disorders (HCR) & Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Department of Cardiology, University of Heidelberg, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
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8
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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
The term Mahaim conduction is conventionally used to describe decrementally conducting connections between the right atrium or the AV node and the right ventricle in or close to the right bundle branch. Although such pathways are rare, their unique properties make their diagnosis and treatment cumbersome. In this article we review the published evidence, and discuss the electrocardiographic and electrophysiological characteristics as well as the anatomy and origin of these fibres.
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Affiliation(s)
| | - Hein J Wellens
- Cardiovascular Research Institute, Maastricht, the Netherlands
| | - Mark E Josephson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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10
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Atriofascicular pathway detection with novel ablation catheter. J Arrhythm 2016; 32:491-492. [PMID: 27920835 PMCID: PMC5129113 DOI: 10.1016/j.joa.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/09/2016] [Accepted: 03/16/2016] [Indexed: 11/22/2022] Open
Abstract
Atriofascicular pathways are a rare cause of antidromic atrioventricular reciprocating tachycardia. The IntellaTip MiFi ablation catheter (Boston Scientific, MA, USA) is a novel ablation catheter that allows enhanced signal clarity with highly localized electrograms. This is the first report of this catheter being successfully used to map and ablate the atriofascicular pathway potentials.
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Abstract
The classic electrocardiogram in Wolff-Parkinson-White (WPW) syndrome is characterized by a short PR interval and prolonged QRS duration in the presence of sinus rhythm with initial slurring. The clinical syndrome associated with above electrocardiogram finding and the history of paroxysmal supraventricular tachycardia is referred to as Wolff-Parkinson-White syndrome. Various eponyms describing accessory or anomalous conduction pathways in addition to the normal pathway are collectively referred to as preexcitation syndromes. The latter form and associated eponyms are frequently used in literature despite controversy and disagreements over their actual anatomical existence and electrophysiological significance. This communication highlights inherent deficiencies in the knowledge that has existed since the use of such eponyms began. With the advent of curative ablation, initially surgical, and then catheter based, the knowledge gaps have been mostly filled with better delineation of the anatomic and electrophysiological properties of anomalous atrioventricular pathways. It seems reasonable, therefore, to revisit the clinical and electrophysiologic role of preexcitation syndromes in current practice.
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12
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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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13
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Liao Z, Ma J, Hu J, Yang Q, Zhang S. New observation of electrocardiogram during sinus rhythm on the atriofascicular and decremental atrioventricular pathways/clinical perspective: [corrected] terminal QRS [corrected] complex slurring or notching. Circ Arrhythm Electrophysiol 2011; 4:897-901. [PMID: 21985794 DOI: 10.1161/circep.111.967224] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atriofascicular and decremental atrioventricular pathways are variants of accessory pathways with anterograde decremental conduction properties. They result in typical wide Quantronic Resonance System (QRS) tachycardia of left bundle branch block morphology. Data on the sinus rhythm electrocardiographic characteristics are limited. METHODS AND RESULTS Thirty patients with accessory pathways of anterograde decremental conduction properties were studied retrospectively (10 atriofascicular pathways and 20 decremental atrioventricular pathways). All patients had a pre-excited atrioventricular tachycardia with anterograde conduction over anterograde decrementally conducting fiber. Eighteen patients fulfilled criteria of minimal pre-excitation during sinus rhythm before ablation. In 10 patients (33%), delta wave was absent, and the only abnormality was terminal QRS slurring or notching on the ECG. It was mainly in leads I, V5, and V6. After ablation, terminal QRS slurring or notching disappeared in all 10 patients. We also did a survey in a control group comprised of 200 subjects without structural heart disease who were matched for age and sex. Terminal QRS slurring or notching was found in 3%. CONCLUSIONS This study showed a high prevalence of terminal QRS slurring or notching in patients with atriofascicular or decremental atrioventricular pathways. It can be the sole manifestation of such accessory pathways during sinus rhythm, and disappearance of terminal slurring or notching can be the only hallmark of successful ablation visible on the surface ECG.
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Affiliation(s)
- Zili Liao
- Center for Arrhythmia Diagnosis and Treatment, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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CAPULZINI LUCIO, PAPARELLA GAETANO, CHIERCHIA GIANBATTISTA, DE ASMUNDIS CARLO, SARKOZY ANDREA, BRUGADA PEDRO. Different Narrow QRS Morphologies in the Surface ECG: What is the Mechanism? J Cardiovasc Electrophysiol 2009; 20:952-4. [DOI: 10.1111/j.1540-8167.2008.01429.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: 11/27/2022]
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15
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Bohora S, Tharakan J. Ablation techniques for mahaim fiber tachycardia. Indian Pacing Electrophysiol J 2009; 9:75-80. [PMID: 19308275 PMCID: PMC2655068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Mahaim fiber exhibits atrio-ventricular node like properties and generally is localized at the lateral aspect of the tricuspid annulus. Of the varying methods for localization, ablation at the site of Mahaim potential is the most accepted and successful method. Radiofrequency ablation of Mahaim fiber has high success rates.
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Affiliation(s)
- Shomu Bohora
- Consultant, Baroda Heart Institute and Research Centre, Vadodara, India
| | - Jaganmohan Tharakan
- Professor and Head of Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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16
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Bohora S, Dora SK, Namboodiri N, Valaparambil A, Tharakan J. Electrophysiology study and radiofrequency catheter ablation of atriofascicular tracts with decremental properties (Mahaim fibre) at the tricuspid annulus. Europace 2008; 10:1428-33. [DOI: 10.1093/europace/eun283] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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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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18
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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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Kothari S, Gupta AK, Lokhandwala YY, Vora AM, Kerkar PG, Thakur RK. Atriofascicular Pathways: Where to Ablate? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1226-33. [PMID: 17100675 DOI: 10.1111/j.1540-8159.2006.00527.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atriofascicular accessory pathway (AP), often referred to as Mahaim pathway, is an uncommon form of preexcitation. The usual target for ablation is at the site of a high-frequency potential along the tricuspid annulus (TA). We present our observations in mapping and ablation of 29 patients with atriofascicular APs. METHODS AND RESULTS Twenty-nine consecutive patients who underwent radiofrequency ablation (RFA) for atriofascicular pathways comprised the series. Demographic factors, clinical features of the tachycardia, ablation site, and results were analyzed. The mean age was 19 +/- 8 years; 15 were men. Three patients had Ebstein's anomaly of the tricuspid valve. Four patients had an additional AP and two patients had concomitant typical atrioventricular nodal reentrant tachycardia. RFA was successful in 28 patients (97%); repeat ablation was required in two patients. The site of successful ablation was on the TA at the site of a sharp, high frequency potential in 15 patients (52%). In the remaining 14 patients, a potential was not found along the TA, and ablation was targeted at the ventricular insertion of the AP into the distal right bundle. At the successful ventricular ablation site, local ventricular activation preceded the surface electrocardiogram by 20 +/- 6 ms. Eight of the 14 patients (57%) undergoing ablation in the ventricle, developed right bundle branch block (RBBB). One patient who underwent successful ablation along the TA also manifested RBBB after ablation; however, this patient had Ebstein's anomaly and preexcitation had completely masked the RBBB. The mean procedure and fluoroscopy time was 150 +/- 32 and 35 +/- 12 minutes, respectively. CONCLUSIONS In atriofascicular pathways, an AP potential was found along the TA in only 52% of patients. Ablation at the ventricular insertion site often resulted in RBBB (57%), but the AP was also successfully ablated.
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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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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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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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Sternick EB, Timmermans C, Sosa E, Cruz FES, Rodriguez LM, Fagundes MA, Gerken LM, Wellens HJJ. The electrocardiogram during sinus rhythm and tachycardia in patients with Mahaim fibers: the importance of an "rS" pattern in lead III. J Am Coll Cardiol 2004; 44:1626-35. [PMID: 15489095 DOI: 10.1016/j.jacc.2004.07.035] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Revised: 05/28/2004] [Accepted: 07/14/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of the study was to identify the electrocardiographic (ECG) characteristics of the Mahaim fiber. BACKGROUND Mahaim fibers are slowly conducting accessory pathways reaching into the right ventricle. They often play a role in tachycardias. METHODS We retrospectively analyzed 40 patients with Mahaim fibers. Five patients had associated Wolff-Parkinson-White syndrome and were excluded from the study. Two patients had a short atrioventricular decremental accessory pathway and were also excluded. The remaining 33 patients had a tachycardia with anterograde conduction over a Mahaim fiber. Twenty were female. Their mean age was 24 +/- 10 years. RESULTS The most common pattern of minimal preexcitation during sinus rhythm was an rS pattern in lead III. This was found in 20 patients. There was a match between the presence of rS in lead III during sinus rhythm and left axis deviation during tachycardia with anterograde conduction over the Mahaim fiber. After ablation, a different QRS pattern emerged in lead III, indicating the absence of conduction over the Mahaim fiber. To obtain information on the prevalence of an rS pattern in lead III in age-matched controls with palpitations and without structural heart disease, the 12-lead ECG of 200 young individuals were examined. An rS pattern in lead III was found in 6%. CONCLUSIONS A narrow QRS with an rS pattern in lead III during sinus rhythm in a patient with a history of palpitations should alert the physician to the possibility of a Mahaim fiber. During tachycardia, these patients typically show a left bundle branch block-like QRS complex with left axis deviation.
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Affiliation(s)
- Eduardo Back Sternick
- Biocor Instituto, rua Correias 281/301, Belo Horizonte, Minas Gerais, 30315-340 Brazil.
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Lau EW, Green MS, Birnie DH, Lemery R, Tang ASL. Preexcitation masking underlying aberrant conduction: An atriofascicular accessory pathway functioning as an ectopic right bundle branch. Heart Rhythm 2004; 1:497-9. [PMID: 15851206 DOI: 10.1016/j.hrthm.2004.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Accepted: 06/16/2004] [Indexed: 11/29/2022]
Abstract
Preexcitation and aberrant conduction both cause a broad QRS complex. An unusual case of an atriofascicular accessory pathway effectively functioning as an ectopic right bundle branch and responsible for both physiologically normal ventricular activation and pathologic preexcited tachycardias as part of a split AV node-bundle branch system is presented.
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Affiliation(s)
- Ernest W Lau
- University of Ottawa Heart Institute, Ontario, Canada
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Sternick EB, Sosa EA, Timmermans C, Cruz Filho FE, Rodriguez LM, Gerken LM, Scanavacca MI, Fagundes ML, Bueno SC, Vrandecic MO, Wellens HJJ. Automaticity in Mahaim Fibers. J Cardiovasc Electrophysiol 2004; 15:738-44. [PMID: 15250854 DOI: 10.1046/j.1540-8167.2004.03615.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Automatic rhythms associated with Mahaim fibers usually occur during radiofrequency catheter ablation. The incidence and significance of spontaneous automaticity in Mahaim fibers are unknown. METHODS AND RESULTS Spontaneous automatic rhythms were observed in 5 (12.5%) of 40 patients with Mahaim fibers referred for nonpharmacologic therapy because of recurrent episodes of symptomatic tachyarrhythmias, usually antidromic circus movement tachycardia (33/40 patients). Three were female and two were male. Their mean age was 15 +/- 7 years compared to 26 +/- 13 years of the patients without automaticity (P = 0.09). Three patients had both antidromic tachycardia and asymptomatic spontaneous automatic rhythms recorded during ambulatory ECG (1 patient) or electrophysiologic study (2 patients). In 2 patients, the automatic rhythm triggered antidromic tachycardia. Two other patients had nonsustained repetitive episodes of wide QRS tachycardia due to automaticity arising in the Mahaim fiber, without antidromic tachycardia. All automatic rhythms were abolished by successful catheter ablation of the Mahaim fibers. CONCLUSION Spontaneous automaticity occurred in 12.5% of our Mahaim patients and may trigger antidromic tachycardia. Spontaneous automaticity, which is not seen in rapidly conducting accessory pathways, is another argument for the presence of an AV nodal-like structure in Mahaim fibers.
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Sternick EB. Mahaim fibre tachycardia: recognition and management. Indian Pacing Electrophysiol J 2003; 3:47-59. [PMID: 16943957 PMCID: PMC1513516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Localization and radiofrequency ablation of atriofascicular pathways using electroanatomic mapping. J Electrocardiol 2003. [DOI: 10.1054/jelc.2003.50016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lau EW, Pathamanathan RK, Ng GA, Griffith MJ. Electrocardiographic criteria for diagnosis of irregular broad complex tachycardia with a high sensitivity for preexcited atrial fibrillation. Pacing Clin Electrophysiol 2000; 23:2040-5. [PMID: 11202244 DOI: 10.1111/j.1540-8159.2000.tb00773.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AF may appear as an irregular broad complex tachycardia (BCT) if atrioventricular conduction occurs via an accessory pathway (preexcited AF) or if bundle branch block (BBB), preexistent or rate related, exists in the His-Purkinje system (BBB-AF). While BBB-AF is relatively benign, preexcited AF may herald sudden cardiac death. Hence it is important that the two conditions can be reliably distinguished. Yet, there is no preexistent algorithms for this purpose. Griffith et al. previously proposed a simple algorithm for a similar problem, that of distinguishing the two differential diagnoses for regular BCT: VT and SVT with BBB, on the basis that unless the QRS morphologies in V1 and V6 are absolutely typical of BBB, VT will be diagnosed. The authors propose an extrapolation of this principle to irregular BCT by stating that, unless the QRS morphologies in V1 and V6 are absolutely typical of BBB, preexcited AF will be diagnosed. Seventy-five ECGs showing irregular BCT (41 preexcited AF and 34 BBB-AF) were shown to two fellows in electrophysiology who were given no other information and were instructed to diagnose preexcited AF unless the QRS morphology pattern was typical of BBB. Observer 1 achieved a sensitivity of 100% (41/41) and a specificity of 79% (27/34), while observer 2 achieved a sensitivity of 100% and a specificity of 85% (29/34). By QRS morphology pattern, an average sensitivity of 100% and specificity of 82% were achieved for the diagnosis of irregular BCT. The algorithm is simple and easy to implement and recommended for clinical use.
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Affiliation(s)
- E W Lau
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
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Gatzoulis KA, Katsivas A, Apostolopoulos T, Avgeropoulou K, Gialafos J, Toutouzas P. Right posterior atrioventricular ring: a location for different types of atrioventricular accessory connections. J Interv Card Electrophysiol 1999; 3:187-91. [PMID: 10387136 DOI: 10.1023/a:1009838018388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present an unusual case of a 28-year-old female patient with recurrent episodes of tachycardias due to participation of two accessory connections located in the posterior tricuspid annulus. Both connections were of the atrioventricular type, the one with non decremental fast conducting properties at the right posteroseptal area, the other with node-like properties at the posterolateral tricuspid ring. Both pathways were successfully ablated transvenously with radiofrequency energy application at the same session. Implications about a common embryological origin of the two pathways as well as review of the literature for similar cases are presented.
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Affiliation(s)
- K A Gatzoulis
- Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
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Berntsen RF, Gjesdal KT, Aass H, Platou ES, Hole T, Orning OM. Radiofrequency catheter ablation of two right Mahaïm-like accessory pathways in a patient with Ebstein's anomaly. J Interv Card Electrophysiol 1998; 2:293-9. [PMID: 9870025 DOI: 10.1023/a:1009701407422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 17-year-old woman with Ebstein's anomaly and recurrent episodes of antidromic tachycardia with two distinct morphologies is described. The tachycardias were produced by two separate Mahaïm-like accessory pathways. These were localized by their activation potentials at the anterolateral ventricular margin of the tricuspid annulus and ablated in a single session using radiofrequency current.
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Affiliation(s)
- R F Berntsen
- Department of Cardiology, Ullevål University Hospital, Oslo, Norway
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Okishige K. Reply to the Editor:. J Cardiovasc Electrophysiol 1998. [DOI: 10.1111/j.1540-8167.1998.tb00935.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: 11/29/2022]
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Okishige K, Goseki Y, Itoh A, Tsuboi N, Sasano T, Azegami K, Ohira H, Yamashita K, Satake S, Hiejima K. New electrophysiologic features and catheter ablation of atrioventricular and atriofascicular accessory pathways: evidence of decremental conduction and the anatomic structure of the Mahaim pathway. J Cardiovasc Electrophysiol 1998; 9:22-33. [PMID: 9475574 DOI: 10.1111/j.1540-8167.1998.tb00863.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Several modalities of catheter ablation have been proposed to eliminate Mahaim pathway conduction. However, limited research has been reported on the electrophysiologic nature of this pathway in its entity. METHODS AND RESULTS In seven patients, electrophysiologic study was performed, and radiofrequency energy was applied to investigate the electrophysiologic clues for successful ablation. In all seven patients, the Mahaim pathway was diagnosed as a right-sided atriofascicular or atrioventricular pathway with decremental properties. In two patients, two different kinds of electrograms were recorded through the ablation catheter positioned at the Mahaim pathway location: one was suggestive of conduction over the decremental portion, demonstrating a dulled potential; and the other of nondecremental conduction, demonstrating a spiked potential. All but one of the Mahaim pathways were eliminated successfully at the atrial origin where the spiked Mahaim potential was recorded. Radiofrequency energy application was performed at the slow potential site resulting in failure to eliminate the conduction over the Mahaim pathway. Conduction block at the site between the slow and fast potential recording sites was provoked by intravenous administration of adenosine, concomitant with a decrease in the amplitude of the Mahaim potential. In one patient, the clinical arrhythmia was a sustained monomorphic ventricular tachycardia originating from the ventricular end of the Mahaim fiber. CONCLUSION The identification of Mahaim spiked potentials may be the optimal method to permit their successful ablation. Detailed electrophysiologic assessment is indispensable for successful ablation of tachycardias associated with Mahaim fibers because tachycardias unassociated with Mahaim fibers can occur despite complete elimination of the Mahaim fiber.
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Affiliation(s)
- K Okishige
- Cardiac Electrophysiology Laboratory, Yokohama Red Cross Hospital, Japan
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