{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:13:29Z","timestamp":1790946809556,"version":"4.1.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1995,2,15]]},"abstract":"<jats:p>\n            <jats:italic>Background<\/jats:italic>\n            Accessory pathways (APs) with anterograde decremental conduction properties referred to as Mahaim fibers have recently been recognized as originating from the right lateral atrium. Little information is available about their distal insertion. The purpose of this study was to determine the different kinds of APs involved and the characteristics of their distal insertion site.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            Twenty-one patients (mean age, 28\u00b113 years) with reciprocating tachycardia or atrial fibrillation were studied. Right-sided atrial and\/or ventricular endocardial mapping during tachycardia identified different types of APs. (1) Seventeen patients had long APs originating from the right lateral atrium and coursing several centimeters to the right ventricle. In 10 patients, the AP terminated in or close to the right bundle-branch system (atriofascicular AP) and in 7, the AP terminated in the anterior right ventricle (atrioventricular AP). Patients with atriofascicular APs had narrower QRS complexes (133\u00b110 versus 165\u00b126 milliseconds,\n            <jats:italic>P<\/jats:italic>\n            =.02) and narrower initial r wave in leads V\n            <jats:sub>2<\/jats:sub>\n            through V\n            <jats:sub>4<\/jats:sub>\n            during maximal preexcitation than patients with atrioventricular APs. In addition, they had earlier His-bundle and right bundle-branch retrograde activation, ie, shorter V-His (16\u00b15 versus 37\u00b19 milliseconds,\n            <jats:italic>P<\/jats:italic>\n            &lt;.01) and V\u2013right bundle intervals (3\u00b15 versus 25\u00b16 milliseconds,\n            <jats:italic>P<\/jats:italic>\n            &lt;.01). In 6 patients, minimal preexcitation not readily apparent was present in sinus rhythm despite the appearance of a narrow QRS complex. A wide distal insertion site of 0.5 to 2 cm in diameter consistent with arborization of the AP was found in 10 patients. The distal application of radiofrequency current produced a change in the preexcitation pattern in 4 patients and ablated the AP in 2 patients. In the other patients, radiofrequency current was applied more proximally and successfully ablated the AP bundle (n=9) or AP proximal insertion (n=6). No recurrence was observed during a follow-up period of 12\u00b110 months. (2) Four patients had short paratricuspid atrioventricular APs; in one, the decremental conduction property was acquired as demonstrated by two electrophysiological studies performed 7 years apart. Radiofrequency ablation was successfully accomplished in all 4 patients at the tricuspid annulus.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            Different types of APs account for tachycardias previously called Mahaim fibers. Long and short atrioventricular APs are observed in 81% and 19%, respectively. Long APs often have a distal arborization and may have either a fascicular or ventricular insertion. Radiofrequency current is more efficient when applied to the AP bundle or AP proximal insertion rather than to the distal insertion in patients with long APs.\n          <\/jats:p>","DOI":"10.1161\/01.cir.91.4.1077","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:34:42Z","timestamp":1339461282000},"page":"1077-1085","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":121,"title":["Characteristics of the Ventricular Insertion Sites of Accessory Pathways With Anterograde Decremental Conduction Properties"],"prefix":"10.1161","volume":"91","author":[{"given":"Michel","family":"Ha\u0131\u0308ssaguerre","sequence":"first","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Cauchemez","sequence":"additional","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Marcus","sequence":"additional","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Le Me\u0301tayer","sequence":"additional","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Lauribe","sequence":"additional","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franck","family":"Poquet","sequence":"additional","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Gencel","sequence":"additional","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Cle\u0301menty","sequence":"additional","affiliation":[{"name":"From the Ho\u0302pital Cardiologique du Haut-Le\u0301ve\u0302que, Avenue de Magellan, 33604 Pessac Ce\u0301dex, France, and Department of Medicine, University of Arizona College of Medicine (F.M.), Tucson, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_1_2","doi-asserted-by":"publisher","DOI":"10.1159\/000164707"},{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.52.2.1149202"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.40.7.806"},{"key":"e_1_3_1_4_2","first-page":"111","volume":"9","year":"1979","unstructured":"Ward DE, Camm AJ, Spurell RAJ. Ventricular preexcitation due to anomalous nodoventricular pathways: report of 3 patients. Eur J Cardiol. 1979;9:111-127.","journal-title":"Eur J Cardiol"},{"key":"e_1_3_1_5_2","first-page":"737","volume":"73","year":"1980","unstructured":"Motte F, Brechenmacher C, Davy JM, Belhassen B. Association de fibres nodo-ventriculaires et atrio-ventriculaires \u00e0 l\u2019origine des tachycardies r\u00e9ciproques. Arch Mal Coeur Vaiss. 1980;73:737-746.","journal-title":"Arch Mal Coeur Vaiss"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.64.1.7237717"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.64.4.7273384"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(82)90446-X"},{"key":"e_1_3_1_9_2","first-page":"155","volume":"76","year":"1983","unstructured":"Motte G, Grolleau R, Rebuffat G, Sebag C, Davy JM, Slama R. Tachycardies r\u00e9ciproques et conduction ant\u00e9rograde par une voie nodo-ventriculaire. Arch Mal Coeur Vaiss. 1983;76:155-166.","journal-title":"Arch Mal Coeur Vaiss"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(84)80163-0"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(87)80020-7"},{"key":"e_1_3_1_12_2","doi-asserted-by":"crossref","unstructured":"Lev M Gibson S Miller RA. Ebstein\u2019s disease with Wolff-Parkinson-White syndrome: report of a case with a histopathologic study of possible conduction pathways. Am Heart J. 1955; 49:724-741.","DOI":"10.1016\/0002-8703(55)90218-0"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.34.5.718"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.34.12.1263"},{"key":"e_1_3_1_15_2","first-page":"27","volume":"3","year":"1975","unstructured":"Anderson RH, Becker AE, Brechenmacher C, Davies MJ, Rossi L. Ventricular preexcitation: a proposed nomenclature for its substrates. Eur J Cardiol. 1975;3:27-36.","journal-title":"Eur J Cardiol"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.57.5.639209"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)39443-7"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a061642"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(84)80109-6"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(82)90531-2"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(83)90453-2"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(86)80270-4"},{"key":"e_1_3_1_23_2","unstructured":"Ross DL Johnson DC Koo CC. Surgical treatment of supraventricular tachycardia without the WPW syndrome: current indications techniques and results. In: Brugada P Wellens HJJ eds. Cardiac Arrhythmias: Where To Go From Here? Mount Kisco NY: Futura Publishing Co; 1987:591-603."},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)90063-8"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.77.4.3127077"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.82.2.2115408"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1991.tb01349.x"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.89.6.8205678"},{"key":"e_1_3_1_29_2","first-page":"51","volume":"15","year":"1992","unstructured":"Tchou PJ, Keim SG, Kinn RM, Rist KE, Setter SF, Adhar G. Electrophysiologic evidence for an ectopic node-His like atrioventricular conduction system in an atriofascicular pathway. PACE Pacing Clin Electrophysiol. 1992;15:51. Abstract.","journal-title":"PACE Pacing Clin Electrophysiol"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(93)90192-C"},{"key":"e_1_3_1_31_2","first-page":"50A","volume":"21","year":"1993","unstructured":"Cappato R, Hebe J, Schl\u00fcter M, G\u00fcrsoy S, Kuck KH. Observations on accessory connections with decremental conduction properties during radiofrequency current ablation. J Am Coll Cardiol. 1993;21:50A. Abstract.","journal-title":"J Am Coll Cardiol"},{"key":"e_1_3_1_32_2","unstructured":"Grogin HR Scheinman MM Lee MA Lee RJ Schamp DJ Epstein LM Lesh MD. Mahaim tracts can arise from either the tricuspid annulus or the atrioventricular node: implications for ablative therapy. Circulation. 1993;88(suppl I):I-62. Abstract."},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.87.3.8443894"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1994.tb01182.x"},{"key":"e_1_3_1_35_2","first-page":"293","volume":"3","year":"1988","unstructured":"Haissaguerre M, Warin JF, Le M\u00e9tayer P, Guillem JP, Blanchot P. Apport de l\u2019enregistrement du potentiel sp\u00e9cifique dans l\u2019expression des voies accessoires. Arch Mal Coeur Vaiss. 1988;3:293-300.","journal-title":"Arch Mal Coeur Vaiss"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.85.6.1591833"},{"key":"e_1_3_1_37_2","unstructured":"Alanis J. Propagation of impulses through the specialized tissues of the mammalian heart. In: Paes de Carvalho A De Mello WC Hoffman BF eds. The Specialized Tissues of the Heart. New York NY: Elsevier Science Publishing Co; 1960:175-201."},{"key":"e_1_3_1_38_2","unstructured":"Guiraudon CM Guiraudon GM Klein GJ. \u201cNodal ventricular\u201d Mahaim pathway: histologic evidence for an accessory atrioventricular pathway with an AV node-like morphology. Circulation. 1988;78(pt 2):II-40."},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(73)80084-0"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a061827"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.91.4.1077","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T16:07:39Z","timestamp":1715530059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.91.4.1077"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1995,2,15]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[1995,2,15]]}},"alternative-id":["10.1161\/01.CIR.91.4.1077"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.91.4.1077","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,2,15]]},"assertion":[{"value":"1994-08-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"1994-09-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"1995-02-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}