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[Radiofrequency catheter ablation in patients with Mahaim-type slow-conduction accessory right atrioventricular pathway].
Cardiologia. 1994 Mar; 39(3):169-80.C

Abstract

In some cases undergoing radiofrequency catheter ablation (RFCA) of accessory pathway (AP), a Mahaim-like right-sided atrioventricular AP (M-AP) showing slow and decremental conduction is observed. Among 200 consecutive patients referred to our Institution up to September 1993 for arrhythmias related to an AP and undergoing RFCA, 8 patients (6 males, 2 females; mean age 24 +/- 8 years, range 8-35) showed a M-AP. Seven out of 8 patients have been complaining episodes of palpitation for 13 +/- 7 years (range 1-20), while 1 subject was an asymptomatic young athlete. In 2/8 patients an Ebstein disease (Eb) was present and they had previously undergone right-sided Kent bundle (Kb) ablation elsewhere. During sinus rhythm, QRS was normal in 1 patient, while it showed ventricular preexcitation due to right-sided Kb in 3 patients and right bundle branch block in another 4 patients. A left bundle branch block morphology (LBBBM) reentrant tachycardia (RT) was observed in 7 patients (in 1, only after RFCA of a right-sided Kb); 3 showed also orthodromic RT. In the asymptomatic young athlete, a preexcitation atrial fibrillation with very rapid ventricular response was inducible. All patients underwent diagnostic electrophysiologic (EP) study and RFCA in the same session. In 2/8 patients M-AP was manifest only after right-sided Kb RFCA. In all patients, associated EP abnormalities were noted: in 5/8 patients a dual A-V node pathway was present and in 5/8 patients 6 right-sided Kbs were associated. Patients have been divided in 3 groups, according to the mechanism involving the M-AP in the RT. In the 2 Group I patients showing also Eb, antidromic LBBBM RT and orthodromic RT involving the M-AP anterogradely and retrogradely, respectively, were observed; both arrhythmias were abolished by ablating the M-AP. The 3 Group II patients showed only antidromic LBBBM RT, involving a fast A-V node pathway retrogradely; also in these patients, the M-AP was the target of RFCA. This was performed only in 1 patient, in whom A-V node RT was also observed and ablated after RFCA of M-AP; as to the other 2 patients, in 1 the ablation of M-AP was not considered mandatory, since it was responsible for inducible not sustained LBBBM RT observed only after RFCA of a Kb in the same EP session, while in the other it was not possible because of a prolonged traumatic conduction block through the M-AP.(

ABSTRACT

TRUNCATED AT 400 WORDS)

Authors+Show Affiliations

Divisione di Cardiologia, IRCCS Policlinico S Matteo, Università degli Studi, Pavia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article

Language

ita

PubMed ID

8039195

Citation

De Ponti, R, et al. "[Radiofrequency Catheter Ablation in Patients With Mahaim-type Slow-conduction Accessory Right Atrioventricular Pathway]." Cardiologia (Rome, Italy), vol. 39, no. 3, 1994, pp. 169-80.
De Ponti R, Storti C, Stanke A, et al. [Radiofrequency catheter ablation in patients with Mahaim-type slow-conduction accessory right atrioventricular pathway]. Cardiologia. 1994;39(3):169-80.
De Ponti, R., Storti, C., Stanke, A., Ferrari, A. A., Longobardi, M., & Salerno-Uriarte, J. A. (1994). [Radiofrequency catheter ablation in patients with Mahaim-type slow-conduction accessory right atrioventricular pathway]. Cardiologia (Rome, Italy), 39(3), 169-80.
De Ponti R, et al. [Radiofrequency Catheter Ablation in Patients With Mahaim-type Slow-conduction Accessory Right Atrioventricular Pathway]. Cardiologia. 1994;39(3):169-80. PubMed PMID: 8039195.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Radiofrequency catheter ablation in patients with Mahaim-type slow-conduction accessory right atrioventricular pathway]. AU - De Ponti,R, AU - Storti,C, AU - Stanke,A, AU - Ferrari,A A, AU - Longobardi,M, AU - Salerno-Uriarte,J A, PY - 1994/3/1/pubmed PY - 1994/3/1/medline PY - 1994/3/1/entrez SP - 169 EP - 80 JF - Cardiologia (Rome, Italy) JO - Cardiologia VL - 39 IS - 3 N2 - In some cases undergoing radiofrequency catheter ablation (RFCA) of accessory pathway (AP), a Mahaim-like right-sided atrioventricular AP (M-AP) showing slow and decremental conduction is observed. Among 200 consecutive patients referred to our Institution up to September 1993 for arrhythmias related to an AP and undergoing RFCA, 8 patients (6 males, 2 females; mean age 24 +/- 8 years, range 8-35) showed a M-AP. Seven out of 8 patients have been complaining episodes of palpitation for 13 +/- 7 years (range 1-20), while 1 subject was an asymptomatic young athlete. In 2/8 patients an Ebstein disease (Eb) was present and they had previously undergone right-sided Kent bundle (Kb) ablation elsewhere. During sinus rhythm, QRS was normal in 1 patient, while it showed ventricular preexcitation due to right-sided Kb in 3 patients and right bundle branch block in another 4 patients. A left bundle branch block morphology (LBBBM) reentrant tachycardia (RT) was observed in 7 patients (in 1, only after RFCA of a right-sided Kb); 3 showed also orthodromic RT. In the asymptomatic young athlete, a preexcitation atrial fibrillation with very rapid ventricular response was inducible. All patients underwent diagnostic electrophysiologic (EP) study and RFCA in the same session. In 2/8 patients M-AP was manifest only after right-sided Kb RFCA. In all patients, associated EP abnormalities were noted: in 5/8 patients a dual A-V node pathway was present and in 5/8 patients 6 right-sided Kbs were associated. Patients have been divided in 3 groups, according to the mechanism involving the M-AP in the RT. In the 2 Group I patients showing also Eb, antidromic LBBBM RT and orthodromic RT involving the M-AP anterogradely and retrogradely, respectively, were observed; both arrhythmias were abolished by ablating the M-AP. The 3 Group II patients showed only antidromic LBBBM RT, involving a fast A-V node pathway retrogradely; also in these patients, the M-AP was the target of RFCA. This was performed only in 1 patient, in whom A-V node RT was also observed and ablated after RFCA of M-AP; as to the other 2 patients, in 1 the ablation of M-AP was not considered mandatory, since it was responsible for inducible not sustained LBBBM RT observed only after RFCA of a Kb in the same EP session, while in the other it was not possible because of a prolonged traumatic conduction block through the M-AP.(ABSTRACT TRUNCATED AT 400 WORDS) SN - 0393-1978 UR - https://www.unboundmedicine.com/medline/citation/8039195/[Radiofrequency_catheter_ablation_in_patients_with_Mahaim_type_slow_conduction_accessory_right_atrioventricular_pathway]_ L2 - https://medlineplus.gov/arrhythmia.html DB - PRIME DP - Unbound Medicine ER -