Characteristics of the Ventricular Insertion Sites of Accessory Pathways With Anterograde Decremental Conduction Properties
| Autor: | B Cauchemez, M. Haissaguerre, J Clémenty, F Marcus, F Poquet, P Lauribe, L Gencel, P Le Metayer |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
Adult
Male Tachycardia medicine.medical_specialty medicine.medical_treatment Bundle-Branch Block Catheter ablation Bundle of His Pre-Excitation Mahaim-Type Electrocardiography Heart Conduction System Physiology (medical) Internal medicine Atrial Fibrillation medicine Humans Atrium (heart) Tachycardia Paroxysmal medicine.diagnostic_test business.industry Cardiac Pacing Artificial Atrioventricular node medicine.anatomical_structure Ventricle Catheter Ablation Cardiology Female medicine.symptom Electrical conduction system of the heart Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 91:1077-1085 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Background Accessory pathways (APs) with anterograde decremental conduction properties referred to as Mahaim fibers have recently been recognized as originating from the right lateral atrium. Little information is available about their distal insertion. The purpose of this study was to determine the different kinds of APs involved and the characteristics of their distal insertion site. Methods and Results Twenty-one patients (mean age, 28±13 years) with reciprocating tachycardia or atrial fibrillation were studied. Right-sided atrial and/or ventricular endocardial mapping during tachycardia identified different types of APs. (1) Seventeen patients had long APs originating from the right lateral atrium and coursing several centimeters to the right ventricle. In 10 patients, the AP terminated in or close to the right bundle-branch system (atriofascicular AP) and in 7, the AP terminated in the anterior right ventricle (atrioventricular AP). Patients with atriofascicular APs had narrower QRS complexes (133±10 versus 165±26 milliseconds, P =.02) and narrower initial r wave in leads V 2 through V 4 during maximal preexcitation than patients with atrioventricular APs. In addition, they had earlier His-bundle and right bundle-branch retrograde activation, ie, shorter V-His (16±5 versus 37±9 milliseconds, P P Conclusions Different types of APs account for tachycardias previously called Mahaim fibers. Long and short atrioventricular APs are observed in 81% and 19%, respectively. Long APs often have a distal arborization and may have either a fascicular or ventricular insertion. Radiofrequency current is more efficient when applied to the AP bundle or AP proximal insertion rather than to the distal insertion in patients with long APs. |
| Databáze: | OpenAIRE |
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