Circulation, Vol 87, 738-747, Copyright © 1993 by American Heart Association
LS Klein, FK Hackett, DP Zipes and WM Miles
BACKGROUND. The purpose of this study was to test the feasibility of
radiofrequency catheter ablation of Mahaim fibers at the tricuspid annulus.
METHODS AND RESULTS. Four patients who fulfilled criteria for having Mahaim
fibers and preexcited reciprocating tachycardia underwent radiofrequency
catheter ablation. Three patients had atriofascicular connections, and one
patient had an atrioventricular connection. The mean age was 27 years (age
range, 11-48 years). All patients had highly symptomatic tachycardias,
producing syncope in one patient and presyncope in the remaining three
patients. Symptoms were present for a mean of 13 years (range, 4-23 years).
All pathways conducted only anterogradely, and preexcitation resulted in a
left bundle branch block QRS morphology. Adenosine caused block in the
accessory pathway in the three patients in whom it was tested. The stimulus
to delta interval increased by 75 msec (range, 35-90 msec) during rapid
atrial pacing. The atrial insertion of the Mahaim fiber was in the right
lateral atrium in one patient, right posterolateral atrium in two patients,
and right posterior atrium in one patient. The ventricular insertion was in
the distal right bundle branch in three patients and in the posterolateral
right ventricle near the tricuspid annulus in the patient with an
atrioventricular connection. Stimulus to delta wave mapping was used to
help localize the atrial insertion of the atriofascicular connections. A
mean of 15 radiofrequency pulses (range, 10-19 pulses) delivered to the
tricuspid annulus in the posterior to lateral regions eliminated accessory
pathway conduction in all patients. No complications occurred. Tachycardia
did not recur during a mean follow-up of 8 months (range, 2-15 months).
CONCLUSIONS. Radiofrequency current applied to the tricuspid annulus can
safely eliminate tachycardia in patients with Mahaim fibers.
ARTICLES
Radiofrequency catheter ablation of Mahaim fibers at the tricuspid annulus
Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202-4800.
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