Mahaim fiber: an atriofascicular or a long atrioventricular pathway?

Heart Rhythm. 2004 Dec;1(6):724-7. doi: 10.1016/j.hrthm.2004.07.015.

Abstract

There is debate concerning the distal insertion of Mahaim fibers. Some findings favor an atriofascicular fiber connected with the distal right bundle branch. Other findings favor a long atrioventricular (AV) structure inserting into the myocardium. A patient having a decrementally conducting accessory pathway is reported. Proximal and distal Mahaim potentials were recorded during sinus rhythm, atrial pacing, and antidromic tachycardia. Both proximal and distal M potentials always preceded the QRS complex during sinus rhythm and antidromic tachycardia earlier than the right bundle branch potential. During tachycardia, the distal M potential was recorded 6 ms before the retrograde right bundle potential. Other arguments consistent with an AV connection were a change in the QRS configuration during tachycardia after the first radiofrequency pulse at the site of the distal M potential and absence of right bundle branch block after successful ablation. Conduction through the proximal part of the Mahaim fiber was unaltered after ablation, as assessed by recording the proximal M potential. Electrophysiologic evidence is presented suggesting a long AV accessory pathway inserting close to the distal right bundle branch rather than an atriofascicular connection in this patient with a Mahaim fiber.

Publication types

  • Case Reports

MeSH terms

  • Action Potentials / physiology
  • Adult
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / surgery
  • Cardiac Pacing, Artificial
  • Catheter Ablation
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac*
  • Female
  • Heart Conduction System / physiopathology*
  • Heart Conduction System / surgery
  • Humans
  • Pre-Excitation, Mahaim-Type / physiopathology*
  • Pre-Excitation, Mahaim-Type / surgery
  • Tachycardia / physiopathology
  • Tachycardia / surgery