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Coexistent atrioventricular and nodoventricular pathways in a patient with hypertrophic cardiomyopathy
A Fitchet1, N J Linker, A P Fitzpatrick
1Manchester Heart Centre, Royal Infirmary, United Kingdom. alan.fitchet@mhc.cmht.nwest.nhs.uk
Insights
This study reports the first case of coexisting Mahaim fibers in a young patient with hypertrophic cardiomyopathy, leading to complex tachycardia. Successful ablation identified dual atrioventricular and nodoventricular connections.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Electrophysiology
Background:
- Concentric hypertrophic cardiomyopathy can present with complex arrhythmias.
- Wide complex tachycardia necessitates thorough electrophysiological evaluation.
Observation:
- A 17-year-old female with hypertrophic cardiomyopathy experienced wide complex tachycardia.
- Electrophysiological study revealed antidromic tachycardia using a decremental atrioventricular fiber and septal retrograde conduction.
Findings:
- Radiofrequency ablation of a right free-wall pathway eliminated tachycardia but left ventricular preexcitation.
- A second nodoventricular connection was identified, indicating coexistent Mahaim fibers.
Implications:
- This is the first reported instance of dual Mahaim fiber connections (atrioventricular and nodoventricular).
- Understanding these dual pathways is crucial for managing complex tachycardias in hypertrophic cardiomyopathy.
Abstract:
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.