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Ablating the ventricular insertion of atrio-fascicular mahaim fiber: could be performed safely?

Ducceschi V, Vitale R, Sokola EA, Ottaviano L, Sangiuolo R, Gregorio G - Indian Pacing Electrophysiol J (2009)

Bottom Line: Small, discrete potentials resembling those of Purkinje fiber were found at right ventricular apex.All these potentials showed early activation during tachycardia preceding the QRS onset of various degree.This case report describes catheter ablation of an atriofascicular accessory pathway by targeting its distal (ventricular) insertion site.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, San Luca Hospital, Vallo della Lucania (SA), Italy. valentino.ducceschi@tin.it

ABSTRACT
We report a patient who underwent radiofrequency ablation of the distal insertion of an atrio-fascicular accessory pathway with decremental properties because of inability to map a suitable potential alongside the tricuspid annulus. Small, discrete potentials resembling those of Purkinje fiber were found at right ventricular apex. All these potentials showed early activation during tachycardia preceding the QRS onset of various degree. Pace mapping helped to localize the presumed main distal insertion of the atrio-fascicular accessory pathway in a region where damage of the His-purkinje system may ensue. This case report describes catheter ablation of an atriofascicular accessory pathway by targeting its distal (ventricular) insertion site.

No MeSH data available.


Related in: MedlinePlus

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Mentions: During incremental atrial pacing, a progressive lengthening of the atrio-ventricular (A-V) interval was noted as well as progressive widening of the QRS and proportional shortening of the His-ventricular (H-V) interval. A wide complex tachycardia exhibiting left bundle branch block (LBBB) morphology and superior axis was induced during pacing at 240 milliseconds (msec) from the high right atrium. The appearance of LBBB morphology was invariably associated with the progressive shortening of the HV interval up to the merging of the His potential with the local ventricular electrogram. After a stable RBB potential recording was obtained it was shown an inversion of the physiologic HB–RBB activation sequence during tachycardia, the HB resulting activated retrogradely. This tachycardia was characterized by an A:V ratio of 1:1 and a concentric retrograde atrial activation pattern (i.e. the earliest retrograde atrial activation was found at the His bundle region). Programmed atrial stimulation at different drive cycles (600-400 msec.) with double and triple extrastimuli successfully initiated tachycardia at coupling interval of less than 300 msec. The arrhythmia onset was always preceded by the occurrence of LBBB aberration of the last paced beat. During the recording session tachycardia cycle length (TCL) varied from 290 msec to 340 msec. These TCL variations were associated to proportional prolongations of V-A interval and QRS duration while the atrial retrograde activation sequence remained unmodified. Despite TCL lengthening and VA prolongation the HA interval remained constant. (Figure 1)


Ablating the ventricular insertion of atrio-fascicular mahaim fiber: could be performed safely?

Ducceschi V, Vitale R, Sokola EA, Ottaviano L, Sangiuolo R, Gregorio G - Indian Pacing Electrophysiol J (2009)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2655074&req=5

Mentions: During incremental atrial pacing, a progressive lengthening of the atrio-ventricular (A-V) interval was noted as well as progressive widening of the QRS and proportional shortening of the His-ventricular (H-V) interval. A wide complex tachycardia exhibiting left bundle branch block (LBBB) morphology and superior axis was induced during pacing at 240 milliseconds (msec) from the high right atrium. The appearance of LBBB morphology was invariably associated with the progressive shortening of the HV interval up to the merging of the His potential with the local ventricular electrogram. After a stable RBB potential recording was obtained it was shown an inversion of the physiologic HB–RBB activation sequence during tachycardia, the HB resulting activated retrogradely. This tachycardia was characterized by an A:V ratio of 1:1 and a concentric retrograde atrial activation pattern (i.e. the earliest retrograde atrial activation was found at the His bundle region). Programmed atrial stimulation at different drive cycles (600-400 msec.) with double and triple extrastimuli successfully initiated tachycardia at coupling interval of less than 300 msec. The arrhythmia onset was always preceded by the occurrence of LBBB aberration of the last paced beat. During the recording session tachycardia cycle length (TCL) varied from 290 msec to 340 msec. These TCL variations were associated to proportional prolongations of V-A interval and QRS duration while the atrial retrograde activation sequence remained unmodified. Despite TCL lengthening and VA prolongation the HA interval remained constant. (Figure 1)

Bottom Line: Small, discrete potentials resembling those of Purkinje fiber were found at right ventricular apex.All these potentials showed early activation during tachycardia preceding the QRS onset of various degree.This case report describes catheter ablation of an atriofascicular accessory pathway by targeting its distal (ventricular) insertion site.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, San Luca Hospital, Vallo della Lucania (SA), Italy. valentino.ducceschi@tin.it

ABSTRACT
We report a patient who underwent radiofrequency ablation of the distal insertion of an atrio-fascicular accessory pathway with decremental properties because of inability to map a suitable potential alongside the tricuspid annulus. Small, discrete potentials resembling those of Purkinje fiber were found at right ventricular apex. All these potentials showed early activation during tachycardia preceding the QRS onset of various degree. Pace mapping helped to localize the presumed main distal insertion of the atrio-fascicular accessory pathway in a region where damage of the His-purkinje system may ensue. This case report describes catheter ablation of an atriofascicular accessory pathway by targeting its distal (ventricular) insertion site.

No MeSH data available.


Related in: MedlinePlus