Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Jan 15;10(1):3504-3507.
doi: 10.19102/icrm.2019.100101. eCollection 2019 Jan.

A Wide Complex Tachycardia in a Structurally Normal Heart: What is the Mechanism? Where to Ablate?

Yash Lokhandwala  1 , Aniruddha Vyas  2
Affiliations
Case Reports

A Wide Complex Tachycardia in a Structurally Normal Heart: What is the Mechanism? Where to Ablate?

Yash Lokhandwala et al. J Innov Card Rhythm Manag. .

Abstract

We present a case of wide complex tachycardia (left bundle branch block, superior axis) in a 30-year-old female with a structurally normal heart and no baseline preexcitation on electrocardiogram. Tachycardia initiation and atrial pacing confirmed the existence and participation of a right-sided atriofascicular decrementally conducting Mahaim pathway. Tachycardia mechanism validation by atrial pacing maneuvers was documented as well as was a response to adenosine and preexcited Mahaim atrial fibrillation. The usual ablation site did not record a Mahaim potential; hence, ablation was performed at a site other than the usual one.

Keywords: Antedromic tachycardia; Mahaim pathway; distal ablation in atriofascicular Mahaim pathway; pre-excited atrial fibrillation via Mahaim pathway.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest for the published content.

Figures

Figure 1:
Figure 1:
A and B: APD delivered from the right atrial free wall during tachycardia. Shown here are surface ECG leads I, aVF, V1, and V6 as well as intracardiac recordings. HRA: high right atrium; HBP/M/D: His bundle proximal, mid, and distal; RBP/D: right bundle proximal and distal; CS: coronary sinus (higher numbers mean proximal electrodes and vice versa).
Figure 2:
Figure 2:
Response to 6-mg adenosine intravenous injection. Shown here are surface ECG leads I, aVF, V1, and V6 as well as intracardiac recordings. HRA: high right atrium; HBP/M/D: His bundle proximal, mid, and distal; RBP/D: right bundle proximal and distal; CS: coronary sinus (higher numbers mean proximal electrodes and vice versa).
Figure 3:
Figure 3:
A 12-lead ECG documented this tachycardia during the study (see Discussion section).
Figure 4:
Figure 4:
Ablation site (black arrow) in the left (A) and right anterior oblique (B) images. C: Corresponding electrograms at the successful ablation site during radiofrequency energy delivery. Shown here are surface ECG leads I, aVF, V1, and V6 as well as intracardiac recordings. HRA: high right atrium; HBP/M/D: His bundle proximal, mid, and distal; RBP/D: right bundle proximal and distal; CS: coronary sinus (higher numbers mean proximal electrodes and vice versa); RFd/p: ablation catheter distal and proximal electrodes.
See this image and copyright information in PMC

Comment in

References

    1. Katritsis DG, Wellens HJ, Josephson ME. Mahaim accessory pathways. Arrhythm Electrophysiol Rev. 2017;6(1):29–32. [CrossRef] [PubMed] - DOI - PMC - PubMed
    1. Sternick EB, Lokhandwala Y, Bohora S, et al. Is the 12-lead electrocardiogram during antidromic circus movement tachycardia helpful in predicting the ablation site in atriofascicular pathways? Europace. 2014;16(11):1610–1618. [CrossRef] [PubMed] - DOI - PubMed
    1. Kothari S, Gupta AK, Lokhandwala YY, Vora A, Kerkar PG, Thakur RK. Atriofascicular pathways: where to ablate? Pacing Clin Electrophysiol. 2006;29(11):1226–1233. [CrossRef] [PubMed] - DOI - PubMed

Publication types

LinkOut - more resources