Ergul Yakup, Akdeniz Celal, Kiplapinar Neslihan, Tuzcu Volkan
Pediatric Cardiology/Electrophysiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey.
Pediatr Cardiol. 2013;34(8):1890-5. doi: 10.1007/s00246-012-0434-1. Epub 2012 Jul 18.
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.
具有递减性房室（AV）结样传导特性的Mahaim纤维占旁路的比例不到3%。在三尖瓣环前外侧至后外侧或右心室游离壁检测到独特的Mahaim电位引导下，对右心房束旁道进行射频消融是一种安全且高效的治疗方法。该病例报告介绍了一名患有埃布斯坦畸形和有症状的宽QRS心动过速的16岁男孩。电生理研究和整个消融过程使用三维标测系统（EnSite Velocity；美国明尼苏达州圣保罗市圣犹达医疗公司）进行。手术过程中未使用荧光透视。电生理评估显示典型的房室结折返性心动过速和Mahaim心动过速，QRS波增宽且呈左束支传导阻滞图形。在Mahaim电位位于三尖瓣环外侧后，使用8毫米尖端导管成功进行了冷冻消融，随后进行慢径路消融以消除典型的房室结折返性心动过速。对于患有Mahaim心动过速的儿童，使用8毫米尖端导管进行冷冻消融可能是一种替代治疗选择。
