Radiofrequency ablation of Mahaim pathway during atrial fibrillation

Abstract

Radiofrequency catheter ablation of accessory pathways has become a well-established therapy with a high rate of success. Intracardiac electrophysiologic study, mapping, and ablation of the pathway are typically performed either in sinus rhythm or during AV reentrant tachycardia. However, atrial fibrillation occurs commonly in these patients (11.5%–39%). 1 Fuster V. Ryden L.E. Asinger R.W. Cannom D.S. Crijns H.J. Frye R.L. Halperin J.L. Kay G.N. Klein W.W. Levy S. McNamara R.L. Prystowsky E.N. Wann L.S. Wyse D.G. Gibbons R.J. Antman E.M. Alpert J.S. Faxon D.P. Gregoratos G. Hiratzka L.F. Jacobs A.K. Russell R.O. Smith Jr, S.C. Alonso-Garcia A. Blomstrom-Lundqvist C. de Backer G. Flather M. Hradec J. Oto A. Parkhomenko A. Silber S. Torbicki A. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001; 22: 1852-1923 Crossref PubMed Scopus (535) Google Scholar It may be the presenting arrhythmia and can occur during the electrophysiologic study. 2 Fujimura O. Klein G.J. Yee R. Sharma A.D. Mode of onset of atrial fibrillation in the Wolff-Parkinson-White syndrome how important is the accessory pathway?. J Am Coll Cardiol. 1990; 15: 1082-1086 Abstract Full Text PDF PubMed Scopus (91) Google Scholar Atrial fibrillation during electrophysiologic study makes mapping and catheter ablation difficult. Previous reports have described ablation of AV accessory pathways during atrial fibrillation using an accessory pathway potential or earliest ventricular activation as a guide. 3 Hindricks G. Kottkamp H. Chen X. Willems S. Haverkamp W. Shenasa M. Breithardt G. Borggrefe M. Localization and radiofrequency catheter ablation of left sided accessory pathway during atrial fibrillation—feasibility and electrogram criteria for identification of appropriate target sites. J Am Coll Cardiol. 1995; 25: 444-451 Abstract Full Text PDF PubMed Scopus (21) Google Scholar , 4 Hindricks G. Kottkamp H. Chen X. Willems S. Breithardt G. Borggrefe M. Successful radiofrequency ablation of right sided accessory pathway during sustained atrial fibrillation. Eur Heart J. 1995; 16: 967-970 PubMed Google Scholar Pathway potential localization can be used to guide ablation of an atriofascicular (Mahaim) pathway during atrial fibrillation. 5 Miller J.H. Harper G.R. Rothman S.A. Hsia H.H. Radiofrequency catheter ablation of an atriofascicular pathway during atrial fibrillation a case report. J Cardiovasc Electrophysiol. 1994; 5: 846-853 Crossref PubMed Scopus (11) Google Scholar However, localization of these potentials is different compared with AV pathways, as illustrated in the following case.