Abbott J A, Scheinman M M, Morady F, Shen E N, Miller R, Ruder M A, Eldar M, Seger J J, Davis J C, Griffin J C
J Am Coll Cardiol. 1987 Aug;10(2):364-72. doi: 10.1016/s0735-1097(87)80020-7.
Six patients with coexistent Mahaim and Kent accessory connections are described. Two had left nodoventricular Mahaim connections, the first reported cases demonstrating these findings. In neither were the left-sided Mahaim connections components of a tachycardia and their presence was incidental. In two of four with nodoventricular connections, associated atrioventricular (AV) node conduction and coexistent posteroseptal accessory pathways were found. One of these had the unusual finding of a right-sided Mahaim connection arising from a "fast" AV node pathway. In only one patient did the tachycardia incorporate the Mahaim connection. In this patient, anterograde conduction during tachycardia occurred over a right nodoventricular connection whereas retrograde conduction occurred through a concealed right free wall Kent connection. Two patients had fasciculoventricular connections that were associated with either septal (one patient) or left free wall (one patient) Kent connections. The latter also had evidence of enhanced AV node conduction. This report is unique in that it describes in detail two patients with left nodoventricular connections (Mahaim) inserting in or near the left posterior fascicle. Combined Kent and Mahaim connections, present in the six patients, appear to occur in approximately 5% of patients with the Wolff-Parkinson-White syndrome. Precise identification of bypass connections critical for reentrant circuits is essential for intelligent application of treatment options.
本文描述了6例并存Mahaim纤维和Kent束旁道的患者。其中2例有左室结节束Mahaim纤维连接，这是首次报道的具有这些表现的病例。这两例患者的左侧Mahaim纤维连接均不是心动过速的组成部分，其存在是偶然发现。在4例有结节束连接的患者中，2例发现存在房室（AV）结传导及并存的后间隔旁道。其中1例有不寻常的表现，即右侧Mahaim纤维连接起源于“快”AV结径路。仅1例患者的心动过速包含Mahaim纤维连接。在该患者中，心动过速时的前向传导通过右侧结节束连接，而逆向传导通过隐匿性右侧游离壁Kent束连接。2例患者有分支室纤维连接，分别与间隔（1例患者）或左侧游离壁（1例患者）Kent束连接并存。后者也有AV结传导增强的证据。本报告的独特之处在于详细描述了2例左室结节束连接（Mahaim纤维）插入左后分支或其附近的患者。6例患者中并存的Kent束和Mahaim纤维连接，似乎在预激综合征患者中约占5%。准确识别对折返环路至关重要的旁路连接，对于合理应用治疗方案至关重要。
