Left atrioventricular accessory pathway with Mahaim fiber characteristics: a rare case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Antidromic atrioventricular re-entrant tachycardia (AVRT) (n=1). Intervention: Catheter radiofrequency ablation. Primary outcome: Termination of tachycardia and absence of recurrence.

Han Jingjing; Ruowen Yuan; Jiazheng Li; Zhiliang Wei; Peng Chang

doi:10.1186/s12872-025-04532-y

February 15, 2025BMC Cardiovascular DisordersOpen Access

Left atrioventricular accessory pathway with Mahaim fiber characteristics: a rare case report

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Key result

Catheter radiofrequency ablation successfully eliminated antidromic atrioventricular re-entrant tachycardia in a patient with a rare left-sided Mahaim accessory pathway, with no recurrence at 6 months.

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Why the study?

Antidromic AVRT is rare and often misdiagnosed as VT, particularly when the accessory pathway conducts slower than the AV junction, obscuring surface ECG preexcitation.

Key Points

Detail the diagnosis and catheter ablation management of a rare left atrioventricular accessory pathway displaying Mahaim fiber characteristics that was initially misdiagnosed as ventricular tachycardia.
Evaluated a 13-year-old male presenting with wide-QRS tachycardia initially diagnosed as ventricular tachycardia.
Conducted an intracardiac electrophysiological study to differentiate the rhythm mechanism and map the accessory pathway.
Performed catheter radiofrequency ablation at the left anterior free wall site and followed the patient for 6 months.
Intracardiac electrophysiology confirmed antidromic atrioventricular re-entrant tachycardia mediated by a left anterior free wall accessory pathway with Mahaim-like properties.
Catheter radiofrequency ablation successfully eliminated the tachycardia, revealing previously concealed ventricular preexcitation upon post-procedure electrocardiogram comparison.
The patient experienced complete freedom from arrhythmia recurrence throughout the 6-month follow-up period.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 13-year-old male patient with intermittent palpitations diagnosed with a rare left atrioventricular accessory pathway with Mahaim fiber characteristics, followed for 6 months after ablation.

I

Intervention

Catheter radiofrequency ablation (40 W energy mode)

O

Outcome

Elimination of tachycardia

Limitations

Single case report
More cases are needed to study the cardiac electrophysiological characteristics of these patients to better understand the left AV Mahaim fibers.
More cases are needed to study the cardiac electrophysiological characteristics of these patients

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Implication

Catheter radiofrequency ablation is an effective treatment for the rare presentation of a left atrioventricular accessory pathway with Mahaim fiber characteristics causing antidromic AVRT.

Abstract

Antidromic atrioventricular re-entrant tachycardia (AVRT) is a rare clinically wide-QRS tachycardia that can often be misdiagnosed as ventricular tachycardia (VT). If the accessory pathway (AP) is slower than the normal atrioventricular (AV) junction, evidence of preexcitation will not appear on the surface electrocardiogram (ECG), which increases the difficulty of diagnosis. This report describes a 13-year-old male patient who was diagnosed with VT at a local hospital at the time of onset of palpitation. ECG revealed wide-QRS-complex tachycardia, and the ECG after the termination of palpitations was within the normal range of sinus rhythm. The patient was confirmed to have an AV accessory pathway on the left anterior free wall with Mahaim fiber features by intracardiac electrophysiological study at our hospital. Wide-QRS-complex tachycardia was confirmed to be antidromic AVRT. We treated the patient with catheter radiofrequency ablation, which eliminated tachycardia. By comparing the ECGs before and after the operation, we observed the hidden manifestation of the ventricular preexcitation wave. There was no recurrence after half a year of follow-up.

Discussion

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Cite This Study

Jingjing et al. (2025) conducted a case report in Antidromic atrioventricular re-entrant tachycardia (AVRT) (n=1). Catheter radiofrequency ablation was evaluated on Termination of tachycardia and absence of recurrence. Catheter radiofrequency ablation successfully eliminated antidromic atrioventricular re-entrant tachycardia in a patient with a rare left-sided Mahaim accessory pathway, with no recurrence at 6 months.

synapsesocial.com/papers/6a7065fa35aa2c282ce1b636 https://doi.org/10.1186/s12872-025-04532-y

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Left atrioventricular accessory pathway with Mahaim fiber characteristics: a rare case report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Left atrioventricular accessory pathway with Mahaim fiber characteristics: a rare case report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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