Successful cryoablation of Mahaim tachycardia in a child with Ebstein's anomaly.
Mahaim fibers with decremental atrioventricular (AV) node-like conduction properties comprise less than 3 % of accessory pathways. Radiofrequency ablation of right atriofascicular pathways guided by a distinct Mahaim potential detected at the anterolateral to posterolateral tricuspid annulus or in the right ventricular free wall is a safe and highly effective treatment method. The case report presents a 16-year-old boy with Ebstein's anomaly and symptomatic wide complex tachyarrhythmia. The electrophysiologic study and the entire ablation procedure were performed using a three-dimensional mapping system (EnSite Velocity; St. Jude Medical Inc., St. Paul, MN, USA). No fluoroscopy was used during the procedure. Electrophysiologic evaluation demonstrated typical atrioventricular nodal reentrant tachycardia and Mahaim tachycardia with a wide QRS and a left bundle branch block pattern. After Mahaim potential was located at the lateral tricuspid annulus, successful cryoablation was performed with an 8-mm-tip catheter followed by slow pathway ablation to eliminate typical atrioventricular nodal reentrant tachycardia. Cryoablation with an 8-mm-tip catheter can be an alternative treatment option for children with Mahaim tachycardia.
Pediatric Cardiology/Electrophysiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey.
Yakup
Y
Ergul
Celal
C
Akdeniz
Neslihan
N
Kiplapinar
Volkan
V
Tuzcu
D058606:Accessory Atrioventricular Bundle / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D003452:Cryosurgery / Q000379:methods*; D004437:Ebstein Anomaly / Q000150:complications*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D011227:Pre-Excitation, Mahaim-Type / Q000150:complications / Q000503:physiopathology / Q000601:surgery*