Cryoablation of a nodoventricular Mahaim fiber.
An 11-year old female presented with paroxysmal tachycardia and was diagnosed with a Mahaim fiber during electrophysiologic study. A preexcited tachycardia and the typical variety of AV nodal reentry tachycardia were induced at different times. During preexcited tachycardia, the His bundle electrogram followed the ventricular electrogram, and, introduction of atrial premature beats at different coupling intervals, advanced the peri-AV nodal atrial tissue, with no change in the ventricular cycle length, leading to a diagnosis of an antidromic tachycardia due to a nodoventricular fiber. Cryoablation at a mid-septal location under three-dimensional guidance successfully eliminated both tachycardias without detrimental effects to the AV node.
Papagiannis
John
J
Division of Pediatric Cardiology, Onassis Cardiac Surgery Center, Athens, Greece, and Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, USA. papagi@otenet.gr
Vachtsevanos
Leonidas
L
Rammos
Spyridon
S
Kanter
Ronald
R
D018780:Body Surface Potential Mapping / Q000379:methods*; D002648:Child; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D011227:Pre-Excitation, Mahaim-Type / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome