Surface electrocardiographic clues suggesting presence of a nodofascicular Mahaim fiber

J Am Coll Cardiol. 1984 May;3(5):1161-8. doi: 10.1016/s0735-1097(84)80173-4.

Abstract

Standard electrocardiograms from 87 consecutive patients with tachycardia of left bundle branch block configuration were analyzed retrospectively for features that might be characteristic of tachycardia utilizing a nodofascicular Mahaim fiber. The study group consisted of 13 patients with nodofascicular tachycardia, 34 with supraventricular tachycardia and aberrant conduction over the His-Purkinje system, 22 with ventricular tachycardia and 18 with antidromic tachycardia utilizing a right-sided accessory atrioventricular pathway. Six variables present during tachycardia of left bundle branch block configuration were predictive of a nodofascicular fiber: cycle length between 220 and 450 ms, QRS axis of 0 to -75 degrees, QRS duration 0.15 second or less, R wave in lead I, rS wave in precordial lead V1 and a precordial transition from a negative to a positive QRS complex after lead V4. All six criteria were present in 16 of the 87 patients. No patient with ventricular tachycardia satisfied these criteria, whereas 3 of 34 with supraventricular tachycardia, 1 of 18 with antidromic tachycardia and 12 of 13 with tachycardia using a nodofascicular fiber did. It is concluded that analysis of the surface electrocardiogram during tachycardia may suggest the presence of a nodofascicular fiber.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Atrioventricular Node / abnormalities*
  • Atrioventricular Node / physiopathology
  • Bundle-Branch Block / diagnosis
  • Bundle-Branch Block / physiopathology
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Electrocardiography*
  • Female
  • Heart Conduction System / abnormalities*
  • Humans
  • Male
  • Retrospective Studies
  • Tachycardia / congenital
  • Tachycardia / diagnosis*
  • Tachycardia / physiopathology