Coexistent atrioventricular and nodoventricular pathways in a patient with hypertrophic cardiomyopathy.
A 17-year-old girl with concentric hypertrophic cardiomyopathy presented with a wide complex tachycardia and underwent electrophysiological study. She was found to have an antidromic tachycardia utilizing a decremental atrioventricular fiber as the anterograde limb with retrograde conduction occurring through the septum. Ablation of a right free-wall pathway rendered tachycardia noninducible, yet ventricular preexcitation remained. After ablation there was evidence of a second nodoventricular connection. We believe this to be the first report of coexistent "Mahaim" fibers; one a decremental atrioventricular connection and the second nodoventricular.
Manchester Heart Centre, Royal Infirmary, United Kingdom. alan.fitchet@mhc.cmht.nwest.nhs.uk
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Fitchet
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Linker
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Fitzpatrick
D000293:Adolescent; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D011227:Pre-Excitation, Mahaim-Type / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000503:physiopathology