Atriofascicular Pathways: Where to Ablate?

Kothari, Snehal; Gupta, Anoop K.; Lokhandwala, Yash; Vora, Amit; Kerkar, Prafulla; Thakur, Ranjan K.

doi:10.1111/j.1540-8159.2006.00527.x

Cited by 27 publications

(30 citation statements)

References 23 publications

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“…In other patients, no M potential will be found at all. In one series, for example, it proved impossible to find M potentials in half of the patients studied . In this situation, mapping of right ventricular activation will be required.…”

Section: Atriofascicular Pathways and Long Atrioventricular Decremenmentioning

confidence: 99%

“…In this situation, mapping of right ventricular activation will be required. Despite previous concerns of a proarrhythmic effect while attempting ablation inside the right ventricle, particularly when close to the ramification of the right bundle branch, none of the eight patients who developed right bundle branch block had incessant tachycardias . Other suggested methods are both time‐consuming and inaccurate.…”

Section: Atriofascicular Pathways and Long Atrioventricular Decremenmentioning

confidence: 99%

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Part II—Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways

Correa

Lokhandwala²,

Filho

et al. 2019

Cardiovasc electrophysiol

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Recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, frequently difficult, challenge for the clinical cardiac arrhythmologist. In this second part of our series of reviews relative to this topic, we discuss the steps required to achieve the correct diagnosis and appropriate management in patients with the so‐called “Mahaim” variants of pre‐excitation. We indicate that, nowadays, it is recognized that these abnormal rhythms are manifest because of the presence of atriofascicular pathways. These anatomical substrates, however, need to be distinguished from the other long and short accessory pathways which produce decremental atrioventricular conduction. The atriofascicular pathways, along with the long decrementally conducting pathways, have their atrial components located within the vestibule of the tricuspid valve. The short decremental pathways, in contrast, can originate in the vestibules of either the mitral or tricuspid valves. As a starting point, careful analysis of the 12‐lead electrocardiogram, taken during both sinus rhythm and tachycardias, should precede any investigation in the catheterization room. When assessing the patient in the electrophysiological laboratory, the use of programmed electrical stimulation from different intracardiac locations, combined with entrainment technique and activation mapping, should permit the establishment of the properties of the accessory pathways, and localization of its proximal and distal ends. This should provide the answer to the question “is the pathway incorporated into the circuit underlying the clinical tachycardia”. That information is essential for decision‐making with regard to need, and localization of the proper site, for catheter ablation.

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Section: Atriofascicular Pathways and Long Atrioventricular Decremenmentioning

confidence: 99%

Section: Atriofascicular Pathways and Long Atrioventricular Decremenmentioning

confidence: 99%

Part II—Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways

Correa

Lokhandwala²,

Filho

et al. 2019

Cardiovasc electrophysiol

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show abstract

“…Pathognomomic electrophysiological characteristics are well described, including unidirectional anterograde conduction with AV node–like decremental properties. Reported targets for ablation include the site of the Mahaim potential along the atrial aspect of the tricuspid annulus or at the ventricular insertion site of the pathway 1 . Spontaneous activity arising from an atriofascicular AP fiber has been described during ablation of its atrial insertion 2 .…”

Section: Introductionmentioning

confidence: 99%

Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber

Venier

Khairy

Thibault

et al. 2016

HeartRhythm Case Reports

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“…Recently unsuccessfull tricuspid annulus mapping for Mahaim discrete potential has been reported to be up to nearly 50 % [11]. When the proximal insertion of Mahaim AP cannot be clearly identified, the ventricular insertion should be targeted for RF ablation once the arrhythmia mechanism has been assessed.…”

Section: Discussionmentioning

confidence: 99%

Ablating the ventricular insertion of atrio-fascicular Mahaim fiber: what selection criteria should we use?

Ducceschi¹,

Vitale²,

Ottaviano

et al. 2009

J Interv Card Electrophysiol

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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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Atriofascicular Pathways: Where to Ablate?

Abstract: 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.

Cited by 27 publications

References 23 publications

Part II—Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways

Part II—Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways

Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber

Ablating the ventricular insertion of atrio-fascicular Mahaim fiber: what selection criteria should we use?

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