Wide QRS supraventricular tachycardia due to coexisting Mahaim and Kent pathways.
In two patients with Wolff-Parkinson-White syndrome, we observed the unusual coexistence of functional Mahaim and accessory atrioventricular pathways. In the first patient, three types of reciprocating tachycardia were demonstrable: (1) anterograde conduction over the atrioventricular (AV) node with right bundle branch block (RBBB) and retrograde conduction via a right-sided atrioventricular accessory pathway; (2) anterograde conduction through the AV node with RBBB and retrograde conduction via two (right-sided and septal) anomalous pathways; and (3) anterograde conduction through nodoventricular fibers and retrograde conduction over a right-sided accessory pathway. In the second patient the reentry circuit was comprised of AV node fasciculoventricular fiber in an anterograde direction and a right-sided accessory pathway in a retrograde direction. We believe this to be the first report of triple accessory pathways, consisting of two atrioventricular and one nodoventricular connection, demonstrated by intracardiac electrophysiologic study.
Sethi
K K
KK
Jaishankar
S
S
Gupta
M P
MP
D000293:Adolescent; D000328:Adult; D001283:Atrioventricular Node / Q000002:abnormalities; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities*; D006801:Humans; D008297:Male; D013610:Tachycardia / Q000209:etiology*; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications