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IAC 2018



Srikant Das, M.D., University of Arkansas for Medical Sciences, Little Rock, AR, USA


1. Unusual accessory pathways: pathways with Mahaim characteristics can be atriofascicular, atrioventricular, nodofascicular and nodoventricular, depending on their variable proximal and distal insertions.
a. Mahaim fiber related tachycardia:
  • Wide QRS tachycardia in young having no structural heart disease.
  • Typically decremental and conducting only anterograde.
  • Anatomically Mahaim fiber is located at the lateral tricuspid annulus in most instances.
  • Mahaim potential good predictor of a successful ablation site
  • "Mahaim" automatic tachycardia (MAT), during RF ablation have been considered as a marker of successful ablation.
  • b. Non-arrhythmic pre-excitation-induced cardiomyopathy: asynchronous ventricular activation over the accessory pathway, especially right-sided, induces septal wall motion abnormalities, ventricular remodeling and ventricular dysfunction. The reversible nature of LV dysfunction after loss of ventricular pre-excitation supports the causal relationship between LV dysfunction and ventricular pre-excitation. We describe the 1st known case of recovery of ventricular function leading to explant of Berlin BiVAD support.

    2. Trans-septal or trans-baffle puncture techniques:
  • SafeSept™ transseptal guidewire (SSTG) use in children
  • Radio frequency energy for perforation
  • Intracardiac echocardiographic guidance

  • 3. Catheter ablation of hemodynamically unstable patients
  • Ventricular assist device/ECMO
  • IMPELLA circulatory pump
  • Local anesthesia and/or sedation only

  • 4. Ablation of para-Hisian substrates by IVC approach, ablation in the non-coronary cusp is not an initial or a preferred approach for pediatric patients.

    5. Complex congenital postoperative anatomy:
    Integration of MRI and electro anatomic mapping

    6. Subcutaneous ICD implant in children: Our center’s experience



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