Catheter-induced mechanical conduction block of right-sided accessory fibers with Mahaim-type preexcitation to guide radiofrequency ablation.

Abstract

The atrial origin of accessory connections with Mahaim-type preexcitation is apparently confined to the anterolateral-to-posterolateral region of the tricuspid annulus. Mechanical conduction block in the atrial input to the accessory fiber induced at the subannular level by catheter manipulation provides an optimal marker to locate the ablation site, even during atrial fibrillation. To expose early recurrence of antegrade accessory pathway conduction, intermittent atrial pacing in the 12 hours after ablation is advisable; in cases of recurrence, a repeat procedure can readily be performed using just the ablation catheter advanced to the target site at the tricuspid annulus.