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At least 19 recordsLinked to original sources
PubMed1975

Coexistence of functional Kent and Mahaim-type tracts in the pre-excitation syndrome. Demonstration by catheter techniques and epicardial mapping.

An unusual patient with Ebstein's anomaly of the tricuspid valve and the Wolff-Parkinson-White syndrome is presented. Ventricular pre-excitation related to conduction over both a right posterior Kent bundle and Mahaim fibers coursing from the atrioventricular node to the right ventricle. Two types of supraventricular tachycardia were demonstrable. These were due to re-entry involving antegrade conduction over either the normal or Mahaim paths, and retrograde retrograde conduction via the Kent bundle. Surgical division of the Kent bundle has abolished the clinically debilitating arrhythmias.

Adult↗
PubMed1992

Flecainide in the Wolff-Parkinson-White syndrome.

The effects of flecainide on electrophysiologic parameters and arrhythmias in the Wolff-Parkinson-White syndrome were reviewed. Acute administration of flecainide blocks conduction across the accessory pathway in the anterograde direction in 40% and in the retrograde direction in 50% of cases and markedly prolongs refractoriness in the remaining cases. Flecainide has a lesser effect on refractoriness of the His-Purkinje system, atrium, ventricle, and atrioventricular node. Flecainide terminates atrioventricular tachycardia in greater than 80% of cases when given intravenously, and oral therapy prevents clinical recurrences in greater than 60% of cases, but may occasionally result in incessant tachycardia. Long-term efficacy is predicted by abolition of conduction across the accessory pathway or prevention of tachycardia induction at acute electrophysiologic testing. Concomitant administration of a beta-adrenoreceptor blocker results in greater long-term efficacy. Administered during preexcited atrial fibrillation, flecainide consistently slows the ventricular response and converts the majority of cases to sinus rhythm. Serious ventricular proarrhythmia is seen almost exclusively in patients with structural cardiac disease. Flecainide is a useful drug for the acute and chronic control of tachycardia in Wolff-Parkinson-White syndrome.

Anti-Arrhythmia Agents↗
PubMed1990

Effect of class Ia antiarrhythmic agents on fasciculoventricular fibers.

In four patients with fasciculoventricular (FV) fibers, the electrocardiographic and electrophysiologic characteristics were studied based on their response to class Ia antiarrhythmic agents. Three patients had paroxysmal atrial fibrillation, and one showed atrioventricular nodal Wenckebach-type block with dual pathways. Three of the four patients showed complete block of FV fibers after administration of disopyramide 0.28-0.60 mg/kg, procainamide 1.7-2.6 mg/kg, and ajmaline 0.18-0.26 mg/kg, respectively. Normalization in the remaining patient was not seen after disopyramide 2 mg/kg or procainamide 10 mg/kg, but was achieved by ajmaline 0.86 mg/kg. Ventricular preexcitation beats showed initial q waves (3 patients) or a decrease in the height of the r wave (1 patient) in V1, no initial q wave in V6 (4 patients), and ST-T changes (1 patient). Since these findings resemble ischemic change or intraventricular conduction disturbance, drug testing is necessary for precise diagnosis and proper clinical management.

Adult↗
PubMed1992

Characteristic findings on the standard 12-lead ECG in patients with the fasciculoventricular Mahaim fiber.

Standard 12-lead electrocardiograms with a Q wave in lead V1 were obtained from 32 subjects without organic cardiac disease and analyzed for features that might characterize an abnormal atrioventricular conduction through the fasciculoventricular Mahaim fiber. Following an infusion of ajmaline, the Q wave in V1 vanished abruptly and changed to an rS pattern in the 12 ajmaline responders. Discriminant analysis was performed to distinguish the ajmaline responders from the others. The explanatory variables were number of precordial leads with the abnormal Q wave, existence of the septal q waves, existence of the slurring of the Q wave in V1, existence of clockwise rotation, and existence of high voltage (RV5 + SV1 > 3.5 mV). Three variables, the absence of the septal q waves, the presence of the slurring, and the absence of clockwise rotation, were found to predict a positive response to ajmaline (discriminant probability = 77%). These findings associated with the Q wave in V1 suggest that the fasciculoventricular fiber may be present.

Adolescent↗
PubMed1989

The scintigraphic characteristics of ventricular pre-excitation through Mahaim fibers with the use of phase analysis.

The phase image pattern of blood pool scintigrams was blindly assessed in 11 patients exhibiting conduction through Mahaim pathways, including 6 nodoventricular and 5 fasciculoventricular. These patterns were compared with the phase image findings in normal subjects, patients with left and right bundle branch block in the absence of pre-excitation and patients with pre-excitation through atrioventricular (AV) connections. In all patients with a Mahaim pathway, the site of earliest phase angle was septal or paraseptal. Phase progression was asymmetric and the pre-excited ventricle demonstrated the earliest mean ventricular phase angle in 10 of 11 patients. This pattern, and the associated ventricular phase difference, appeared to vary from that in normal subjects and in those with a septal AV connection, in whom phase progression is generally symmetric. Scintigraphic phase analysis provided localizing information and presented patterns consistent with Mahaim pathways. Although not able to differentiate among Mahaim pathway subtypes, these phase patterns differed from those in normal subjects, those with right and left lateral free wall pathways and most patients with a septal AV pathway. However, the phase pattern of patients with a Mahaim pathway may not differ from that of patients with a septal AV connection displaying an asymmetric pattern of phase progression, or those with left and right bundle branch block in the absence of pre-excitation. Objective, yet imperfect phase measurements supported these differences. Such image findings may complement the often complex electrophysiologic evaluation of patients presenting with pre-excitation.

Adult↗
PubMed1987

Coexistent Mahaim and Kent accessory connections: diagnostic and therapeutic implications.

Six patients with coexistent Mahaim and Kent accessory connections are described. Two had left nodoventricular Mahaim connections, the first reported cases demonstrating these findings. In neither were the left-sided Mahaim connections components of a tachycardia and their presence was incidental. In two of four with nodoventricular connections, associated atrioventricular (AV) node conduction and coexistent posteroseptal accessory pathways were found. One of these had the unusual finding of a right-sided Mahaim connection arising from a "fast" AV node pathway. In only one patient did the tachycardia incorporate the Mahaim connection. In this patient, anterograde conduction during tachycardia occurred over a right nodoventricular connection whereas retrograde conduction occurred through a concealed right free wall Kent connection. Two patients had fasciculoventricular connections that were associated with either septal (one patient) or left free wall (one patient) Kent connections. The latter also had evidence of enhanced AV node conduction. This report is unique in that it describes in detail two patients with left nodoventricular connections (Mahaim) inserting in or near the left posterior fascicle. Combined Kent and Mahaim connections, present in the six patients, appear to occur in approximately 5% of patients with the Wolff-Parkinson-White syndrome. Precise identification of bypass connections critical for reentrant circuits is essential for intelligent application of treatment options.

Adult↗
PubMed1988

"Nodoventricular" accessory pathway: evidence for a distinct accessory atrioventricular pathway with atrioventricular node-like properties.

Two patients are described with recurrent pre-excited tachycardia and electrophysiologic characteristics typically ascribed to a nodoventricular accessory connection. The accessory pathway in each case demonstrated rate-dependent prolongation of conduction time and a low right ventricular insertion site; it was associated with a left bundle branch block configuration during pre-excitation. Intraoperatively, the pathway was demonstrated to originate at the anterior right atrioventricular (AV) anulus and not at the AV node. These data suggest that a "typical" nodoventricular pathway, by electrophysiologic criteria, may in fact be an AV pathway with AV node-like conduction properties and a distal right ventricular insertion site.

Adult↗
PubMed1989

Cimetidine-related cardiac conduction disturbances and confusion.

A 70-year-old woman free of renal or hepatic dysfunction developed reversible mental confusion, sinus bradycardia, and extreme QT interval prolongation following initiation of intravenous cimetidine 1200 mg daily. The association of mental confusion with cardiac conduction impairment in a single patient in the context of cimetidine toxicity is highly unusual. We review this and other reports on potentially fatal cimetidine-related cardiac conduction disturbances to suggest that in patients at risk, in addition to reducing cimetidine dosage, electrocardiogram (ECG) follow-up is indicated to identify dangerous bradycardia and QT interval prolongation.

Aged↗
PubMed1989

Pharmacological characterization of conduction over a Mahaim fiber: evidence for adenosine sensitive conduction.

The presence of a nodoventricular pathway (Mahaim fiber) has been invoked to explain certain distinctive electrocardiographic and electrophysiological observations. The presence of an atrioventricular or atriofascicular fiber with decremental conduction properties has been documented in many of these patients. We report the case of a patient with a Mahaim fiber and the response to conduction over this pathway after adenosine, procainamide, encainide, verapamil, edrophonium, phenylephrine and isoproterenol. Conduction over the Mahaim fiber was blocked by adenosine, but not verapamil. The time course of adenosine induced block over the Mahaim fiber differed from adenosine induced AV nodal block. Mahaim fibers are decrementally conducting pathways that are adenosine sensitive. These findings support the concept that conduction in accessory pathways manifesting decremental properties is not mediated by the calcium channel.

Adenosine↗
PubMed1991

Diagnosis and surgical treatment of tachycardias in patients with nodoventricular fibers.

From May, 1982 to April, 1991 25 patients were examined and 23 had open heart surgery for tachycardia with nodoventricular fibers (NVF) participation. All patients suffered tachycardia for more than 5 years. Most patients had syncope. The patients had: true NVF tachycardia (11), atrioventricular node reentry tachycardia (5), orthodromic atrioventricular tachycardia (AVT) (5), and atrial flutter (1) all with passive propagation through NVF, pseudonodoventricular tachycardia (AVT with slow accessory pathways) two patients. In 18 out of the 23 who had surgery there were no signs of preexcitation or tachycardia events in the follow-up period.

Adolescent↗
PubMed1991

Hypothesis testing as an approach to the analysis of complex tachycardias--an illustrative case of a preexcitation variant.

The correct elucidation of the electrophysiological substrate and mechanism(s) responsible for a complex arrhythmia requires a systematic approach to the analysis of the electrophysiological data. One approach calls for the formulation of a set of hypotheses that could explain the data obtained during the study. The hypotheses are then tested for compatibility with phenomena observed and the one that agrees with the majority of the findings would represent the most tenable explanation. We present the case of a young girl with a wide QRS complex tachycardia and a history of ventricular preexcitation that illustrates this approach. The complexities were resolved only after intraoperative analysis and surgical ablation of a right-sided accessory pathway with decremental properties, and provides further insight into our understanding of the nodoventricular Mahaim fiber.

Anti-Arrhythmia Agents↗
PubMed1995

Preexcitation in hypertrophic cardiomyopathy: a case of a fasciculoventricular Mahaim fiber.

A patient with hypertrophic cardiomyopathy (HCM) who presented with preexcitation pattern on the surface ECG suggestive of the Wolff-Parkinson-White (WPW) syndrome is described. Intracardiac electrophysiological study revealed a fixed anomalous QRS complex and a short-fixed His-ventricular interval indicating a fasciculoventricular Mahaim fiber. As this specific form of accessory connection does not cause reentrant tachycardias, no treatment was required. It is important to distinguish this entity from atriofascicular or nodoventricular Mahaim fibers or the WPW syndrome in patients with HCM showing a preexcitation pattern in the surface ECG, as these may cause life-threatening arrhythmias in this patient population.

Adult↗
PubMed1995

Radiofrequency catheter ablation of Mahaim tachycardia by targeting Mahaim potentials at the tricuspid annulus.

BACKGROUND: Reentrant tachycardias associated with Mahaim pathways are rare but potentially troublesome. Various electrophysiological substrates have been postulated and catheter ablation at several sites has been described. OBJECTIVE: To assess the efficacy and feasibility of targeting discrete Mahaim potentials recorded on the tricuspid annulus for the delivery of radiofrequency energy in the treatment of Mahaim tachycardia. PATIENTS: 21 patients out of a consecutive series of 579 patients referred to one of three tertiary centres for catheter ablation of accessory pathways causing tachycardia. All had symptoms and presented with tachycardia of left bundle branch block configuration or had this induced at electrophysiological study. In all cases, the tachycardia was antidromic with anterograde conduction over a Mahaim pathway. RESULTS: 6 patients had additional tachycardia substrates (4 had accessory atrioventricular connections and 2 had dual atrioventricular nodal pathways and atrioventricular nodal reentry). After ablation of the additional pathways, Mahaim potentials were identified in 16 (76%) associated with early activation of the distal right bundle branch and radiofrequency energy at this site on the tricuspid annulus abolished Mahaim conduction in all 16 cases. In 2 patients there was early ventricular activation at the annulus without a Mahaim potential but radiofrequency energy abolished pre-excitation. In the remaining patients no potential could be found (1 patient), no tachycardia could be induced after ablation of an additional pathway (1 patient), or no Mahaim conduction was evident during the study (1 patient). During follow up (1-29 months (median 9 months)) all but 1 patient remained symptom free without medication. CONCLUSIONS: Additional accessory pathways seem to be common in patients with Mahaim tachycardias. The identification of Mahaim potentials at the tricuspid annulus confirms that most of these pathways are in the right free wall and permits their successful ablation and the abolition of associated tachycardia.

Adolescent↗
PubMed1988

Atriofascicular connection or a nodoventricular Mahaim fiber? Electrophysiologic elucidation of the pathway and associated reentrant circuit.

Accessory pathways showing decremental properties and inserting into the right ventricle have been frequently described as "nodoventricular" or Mahaim pathways. However, conclusive evidence for a nodal origination of such pathways is lacking. The patient in this study had characteristics typical of such a pathway. Antegradely, the pathway showed decremental, nodelike conduction properties. With the aid of right bundle branch recordings, the pathway was demonstrated to insert directly into the right bundle branch. Atrioventricular reciprocating tachycardia could be readily initiated by atrial or ventricular pacing. The QRS morphology was normal during sinus rhythm and demonstrated a left bundle branch block pattern with normal axis during tachycardia. The reentrant circuit involved antegrade conduction over the accessory pathway and retrograde conduction via the bundle branches, His bundle, and the atrioventricular node. More significantly, late atrial stimuli delivered during tachycardia could preexcite the ventricle via the accessory pathway despite their inability to enter the atrioventricular node. Thus, the upper "turn around" of the reentrant circuit involved atrial tissue and the accessory pathway originated directly from the right atrium independent of the atrioventricular node. In view of these new findings and other recent observations during surgical resection of similar pathways, a reassessment of previous descriptions of "nodoventricular" fibers may be necessary. Many of these pathways may actually represent atriofascicular or atrioventricular connections with decremental properties.

Adolescent↗