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.
A series of four patients with right-sided accessory pathways with long conducting times and decremental properties is reported. All patients underwent radiofrequency catheter ablation, and target areas were guided by a discrete "Mahaim" potential recorded at the lateral aspect of the tricuspid valve. A slow automatic and irregular rhythm with a QRS morphology similar to that of a fully preexcited QRS complex occurred during radiofrequency current delivery. The occurrence of so-called "Mahaim" automatic tachycardia heralded successful elimination of the accessory pathway in a manner similar to that of junctional automatic rhythm during slow pathway ablation in patients with AV nodal reentrant tachycardia. The observation of an automatic rhythm brought about during radiofrequency current ablation of a Mahaim-like accessory pathway is electrophysiologic evidence of the accessory AV nodal behavior of this structure.
Hemodynamic benefits in the stentless group were evident and expressed by larger AEOA, lower gradients, better left ventricular remodeling with significant decrease of the left ventricular mass. Lower complication rates, lower reoperation rates, less leaflet tissue degeneration, and lower valve related mortality rates were seen in the stentless group. A controlled clinical comparison trial with longer follow-up will be required to confirm these clinical and hemodynamic benefits.
Electrophysiologists should be able to make the differential diagnosis between a fasciculoventricular bypass tract and an anteroseptal accessory pathway to preclude potential harm to the AV conduction system if a fasciculoventricular pathway is targeted for catheter ablation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.