This case represents the first report of coexistent 'Mahaim' fibers (one decremental atrioventricular and one nodoventricular) in a patient with hypertrophic cardiomyopathy.
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Alerts to possible multiple pathways in HCM preexcitation; leaves open prevalence and ablation strategies.
A 17-year-old girl with concentric hypertrophic cardiomyopathy presented with a wide complex tachycardia and underwent electrophysiological study. She was found to have an antidromic tachycardia utilizing a decremental atrioventricular fiber as the anterograde limb with retrograde conduction occurring through the septum. Ablation of a right free-wall pathway rendered tachycardia noninducible, yet ventricular preexcitation remained. After ablation there was evidence of a second nodoventricular connection. We believe this to be the first report of coexistent "Mahaim" fibers; one a decremental atrioventricular connection and the second nodoventricular.
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Fitchet et al. (2000) studied this question.
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