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Uncovering a unique path: Antidromic AVRT utilizing a left anteroseptal Mahaim‐like accessory pathway
Author(s) -
Sandhu Amneet,
Tzou Wendy S.,
Borne Ryan T.,
Zipse Matthew M.,
Nguyen Duy T.,
Sauer William H.
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14024
Subject(s) - medicine , coronary sinus , cardiology , atrioventricular reentrant tachycardia , palpitations , accessory pathway , antidromic , presyncope , tachycardia , sinus rhythm , orthodromic , catheter ablation , ablation , atrial fibrillation , electrophysiology , heart rate , blood pressure
Abstract A 40‐year‐old man presented to our emergency department 2 hours after onset of shortness of breath, palpitations, and presyncope secondary to an adenosine‐responsive wide complex tachycardia. Electrophysiology study was diagnostic for antidromic atrioventricular (AV) reentrant tachycardia utilizing a muscular connection from the anterior interventricular vein to the left ventricle with Mahaim‐like properties, successfully treated with ablation in the distal coronary sinus (CS) system. This case highlights accessory pathways (a) with unique features (i.e., Mahaim‐like characteristics) and (b) involving musculature from the distal CS system, thereby limiting the value of endocardial ablation for durable treatment. Importantly, the coronary venous system is an accessible vascular network for evaluation and catheter ablation of such arrhythmias.