Role of Nodoventricular and Fasciculoventricular Connections in Tachyarrhythmias

  • John J. Gallagher


The role of “Mahaim fibers” in the genesis of cardiac arrhythmias in man has been controversial since they were first described [1]. The initial report was limited to fibers connecting the His bundle to the septum but this was soon broadened to include fibers connecting the atrioventricular (AV) node to the septum. Although the existence of these has been confirmed anatomically [2–25], their functional significance has remained controversial [26–80].


Left Bundle Branch Block Accessory Pathway Atrial Pace Versus Node Right Bundle Branch Block 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mahaim I, Benatt A: Nouvelles recherches sur les connexions superieures de la branche gauche du faisceau de His—Tawara avec cloison interventriculaire. Cardiologia 1: 61, 1938.CrossRefGoogle Scholar
  2. 2.
    Mahaim I, Winston MR: Recherches d’anatomie comparee et de pathologie experimentale sur les connexions hautes de faisceau de His—Tawara. Cardiologia 5: 189–260, 1941.CrossRefGoogle Scholar
  3. 3.
    Mahaim I: Kent’s fibers and the A—V paraspecific conduction through the upper connections of the bundle of His—Tawara. Am. Heart J. 33:651, 1947.Google Scholar
  4. 4.
    Lev M, Lerner R: The theory of Kent. A histologic study of the normal atrioventricular communications of the human heart. Circulation 12: 176, 1955.PubMedGoogle Scholar
  5. 5.
    Lev M, Gibson S, Miller RA: Ebstein’s disease with Wolff-Parkinson-White syndrome. Am. Heart J. 49: 724, 1955.PubMedCrossRefGoogle Scholar
  6. 6.
    Truex RC, Bishop JK, Hoffman EL: (1958) Accessory atrioventricular muscle bundles of the developing human heart. Anat Rec 131: 45, 1958.Google Scholar
  7. 7.
    James TN: Morphology of the human atrioventricular node with remarks pertinent to its electrophysiology. Am. Heart J. 62: 756, 1961.PubMedCrossRefGoogle Scholar
  8. 8.
    Lev M, Sodi-Pollares D, Friedland C: A histopathologic study of the atrioventricular communications in a case of WPW with incomplete left bundle branch block. Am. Heart J. 66: 399, 1963.PubMedCrossRefGoogle Scholar
  9. 9.
    Lev M, Leffler WB, Langendorf R, Pick A: Anatomic findings in a case of ventricular pre-excitation (WPW) terminating in complete atrioventricular block. Circulation 34: 718, 1966.PubMedGoogle Scholar
  10. 10.
    Lunel AAV: Significance of annulus fibrosis of heart in relation to AV conduction and ventricular activation in cases of Wolff-Parkinson-White syndrome. Br. Heart J. 34: 1283, 1972.CrossRefGoogle Scholar
  11. 11.
    Okada R, Mizutani T, Mochizuki S: A morphologic study of a case of idiopathic cardiomyopathy which showed the electrocardiographic features of WPW syndrome. Heart 6: 630, 1974.Google Scholar
  12. 12.
    James TN, Marilley RJ Jr, Marriott HJL: De subitaneis mortibus. XI. Young girl with palpitations. Circulation 51: 743, 1975.PubMedGoogle Scholar
  13. 13.
    Bharati S, Lev M: The course of the conduction system in single ventricle with inverted (L-) loop and inverted (L-) transposition. Circulation 51: 723, 1975.PubMedGoogle Scholar
  14. 14.
    Lev M, Fox SM, Bharati S, Greenfield JC Jr, Rosen KM, Pick A: Mahaim and James fibers as a basis for a unique variety of ventricular preexcitiation. Am. J. Cardiol. 36: 880, 1975.PubMedCrossRefGoogle Scholar
  15. 15.
    Anderson RH, Becker AE, Brechenmacher C, Davies MJ, Rossi L: Ventricular preexcitation. A proposed nomenclature for its substrates. Eur. J. Cardiol. 3: 27, 1975.PubMedGoogle Scholar
  16. 16.
    Brechenmacher C, Courtadon M, Jourde M, Yermia JC, Cheynee J, Voegtlin R: Syndrome de Wolff-Parkinson-White par association de fibres atrio-hissiennes et de fibres de Mahaim. Arch. Mal. Coeur. 69: 1275, 1976.PubMedGoogle Scholar
  17. 17.
    Becker AE, Anderson RH: Morphology of the human atrioventricular junctional area. In: The Conduction System of the Heart. Edited by HJJ Wellens, KI Lie, MJ Janse. Leiden, HE Stenfert Kroese BV, 1976, pp. 263–286.Google Scholar
  18. 18.
    Anderson RH, Wenick AC, Losekoot TG, Becker AE: Congenitally complete heart block. Development aspects. Circulation 56: 90, 1977.PubMedGoogle Scholar
  19. 19.
    Becker AE, Anderson RH, Durrer D, Wellens HJJ: The anatomic substrates of WolffParkinson-White syndrome. Circulation 57: 870, 1978.PubMedGoogle Scholar
  20. 20.
    Bharati S, Bauernfiend R, Scheinman M, Massie B, Cheitlin M, Denes P, Wu P, Lev M, Rosen KM: Congenital abnormalities of the conduction system in two patients with tachyarrhythmias. Circulation 59: 593, 1979.PubMedGoogle Scholar
  21. 21.
    Brechenmacher C: In: Les troubles du rhytme cardiaque, Le Group de Rythmologie de la Societé Francaise de Cardiologie. Roussel, Paris, 1979, pp. 13–19.Google Scholar
  22. 22.
    Bharati S, Lev M: The conduction system in hypoplasia of the aortic tract complex. Circulation 59: 1324, 1979.PubMedGoogle Scholar
  23. 23.
    Thiene G, Pennelli N, Rossi L: Cardiac conduction system abnormalities as a possible cause of sudden death in young athletes. Hum Pathol Aug 14: 704, 1983.CrossRefGoogle Scholar
  24. 24.
    Rossi L, Thiene G: Arrhythmologic pathology of sudden cardiac death. Casa Editrice Ambrosiana, Milano, 1983.Google Scholar
  25. 25.
    Marino TA, Kane BM: Cardiac atrioventricular junctional tissues in hearts from infants who died suddenly. JACC 5: 1178, 1985.PubMedGoogle Scholar
  26. 26.
    Pick A, Katz LN: Disturbance of impulse formation and conduction in the preexcitation syndrome: their bearing on its mechanism. Am. J. Med. 19: 759, 1955.PubMedCrossRefGoogle Scholar
  27. 27.
    Massumi RA: His bundle recordings in bilateral bundle branch block combined with WPW syndrome: Antegrade type II (Mobitz) block and 1:1 retrograde conduction through the anomalous bundle. Circulation 42: 287, 1970.PubMedGoogle Scholar
  28. 28.
    Coumel P, Waynberger M, Slama R, Bouvrain Y: Interest de l’enregistrement des potentiels hisienes au cours du syndrome de Wolff-ParkinsonWhite. A propos de six observations. Acta. Cardiol. 26: 188, 1971.PubMedGoogle Scholar
  29. 29.
    Wellens HJJ: Eectrical Stimulation of the Heart in the Study and Treatment of Tachycardias. University Park Press, Baltimore, Maryland, 1971, p. 97.CrossRefGoogle Scholar
  30. 30.
    Moore EN: Electrophysiological studies on preexcitation in dog using an electronically simulated atrioventricular bypass pathway. Circ. Res. 31: 174, 1972.PubMedGoogle Scholar
  31. 31.
    Coumel P, Wayneberger M, Fabiato A, Slama R, Aigueperse A, Bouvrain Y: Wolff-ParkinsonWhite syndrome: problems in evaluation of multiple accessory pathways and surgical therapy. Circulation 45: 1216, 1972.PubMedGoogle Scholar
  32. 32.
    Marco J, Salvador M, Couderc JJ, Dardenne P: Syndrome de Wolff-Parkinson-White avec PR normal: preexcitation du type Mahaim, association probable d’ un faisceau de Kent. Etude du potentiel hisien. Rev Med Toulouse 8: 229, 1972.Google Scholar
  33. 33.
    Stefanov G: Paroxysmal tachycardia in the probable presence of Mahaim’s fibers. Vutr Boles 12: 124, 1973.PubMedGoogle Scholar
  34. 34.
    Stefanov G: Three electrocardiographic variants of paroxysmal tachycardia with the probable presence of Mahaim fibers. Vutr Boles 13: 42, 1974.PubMedGoogle Scholar
  35. 35.
    Mark AL, Basta LL: (1974) Paroxysmal tachycardia with atrioventricular dissociation in a patient with a variant of preexcitation syndrome. J. Electrocardiol 7: 355, 1974.Google Scholar
  36. 36.
    Castellano A, Agha AS, Befeller B, Myerburg RJ: Double accessory pathways in WolffParkinson-White syndrome. Circulation 51: 1020, 1975.Google Scholar
  37. 37.
    Tonkin AM, Dugan FA, Svenson RH, Sealy WC Wallace AG, Gallagher JJ: Coexistence of functional Kent and Mahaim-type tracts in the preexcitation syndrome. Demonstration by catheter techniques and epicardial mapping. Circulation 52: 193, 1975.PubMedGoogle Scholar
  38. 38.
    Touboul P, Huerta F, Arnaud P, Porte J, Delahaye JP: Etude electrophysiologique de deux cas de preexcitation ventriculaire compatibles avec la presence de fibres de Mahaim. Arch. Mal. Coeur. 68: 841, 1975.PubMedGoogle Scholar
  39. 39.
    Gallagher JJ, Sealy WC, Kasell J, Wallace AG: Multiple accessory pathways in patients with the preexcitation syndrome. Circulation 54: 571, 1976.PubMedGoogle Scholar
  40. 40.
    Okumura M, Koike Y, Hattori M, Tsuzuke J, Tanahashi Y: A case of preexcitation syndrome due to possible Mahaim-fiber conduction. Respir. Circ. 24: 891, 1976.Google Scholar
  41. 41.
    Castellanos A, Sung RJ, Castillo CA, Agha AS, Befeler B, Myerburg RJ: His bundle recordings in diagnosis of impulse formation in Kent and Mahaim tracts. Br. Heart J. 38: 1173, 1976.PubMedCrossRefGoogle Scholar
  42. 42.
    Touboul P, Gressard A, Vexler RM, Chatelain MT: Unusual re-entrant tachycardias associated with accessory pathways. In: Reentrant Arrhythmias. Edited by HE Kulbertus, MTP Press Ltd., Lancaster, 1977, pp. 132–143.Google Scholar
  43. 43.
    Donzeau JP, Constans R, Bernadet P, Bounhoore JP, Calazel P: Nodal tachycardia with atrioventricular dissociation probably connected with Mahaim’s bundle undetectable in sinus rhythm. Ann Cardiol Angeiol 26: 413, 1977.Google Scholar
  44. 44.
    Neuss H Thormann J: Functional properties of Mahaim fibers. KIM. Wochenschr 55: 1031, 1977.CrossRefGoogle Scholar
  45. 45.
    Gomes JA, Haft JI: His bundle electrocardiography in the Wolff-Parkinson-White syndrome. Evidence for combination of James and Mahaim conduction. Cardiologia 62: 355, 1977.CrossRefGoogle Scholar
  46. 46.
    Ikram H: Direct demonstration of pure infranodal preexcitation (Mahaim conduction) by A-V nodal and His bundle electrography. Angiology 28: 376, 1977.PubMedCrossRefGoogle Scholar
  47. 47.
    Probst P, Pachinger U, Steinbach R, Kaindl F: Preexcitation of the ventricle associated with total intra His bundle block. Am. Heart J. 94: 96, 1977.PubMedCrossRefGoogle Scholar
  48. 48.
    Motte G, Guillevin L, Dessouter P, Fruchaud J: (1978) Nodo-ventricular accessory pathway unmasked by a block in the trunk of the bundle of His. Arch. Mal. Coeur. 71: 227, 1978.Google Scholar
  49. 49.
    Touboul P, Vexler RM, Chatelain MT: Re-entry via Mahaim fibres as a possible basis for tachycardia. Br. Heart J. 40: 806, 1978.PubMedCrossRefGoogle Scholar
  50. 50.
    Boroumand K, Armstrong PW: Preservation of preexcitation despite acute myocardial infarction complicated by complete heart block. Can. Med. Assoc. J. 119: 139, 1978.Google Scholar
  51. 51.
    Matsuguchi H, Takeshita A, Makino N, Tanaka S, Nakagaki U, Kuroiwa A, Nakamura M.: Mahaim conduction producing left axis deviation and normal QRS. Br. Heart J. 40: 902, 1978.PubMedCrossRefGoogle Scholar
  52. 52.
    Rossi L, Thiene G, Knippel M: A case of surgically corrected Wolff-Parkinson-White syndrome. Clinical and histological data. Br. Heart J. 40: 581, 1978.PubMedCrossRefGoogle Scholar
  53. 53.
    Benditt DG, Pritchett ELC, Gallagher JJ: Spectrum of regular tachycardias with wide QRS complexes in patients with accessory atrioventricular pathways. Am. J. Cardiol. 42: 828, 1978.PubMedCrossRefGoogle Scholar
  54. 54.
    Long-Tai Fu, Iunama H, Watanabe T, Koyama S: Functional accessory pathway in ventricular preexcitation without short P-R. VIII World Congress of Cardiology Abstracts I1: 31, 1978.Google Scholar
  55. 55.
    Ward DE, Camm AJ, Spurrell RAJ: Ventricular preexcitation due to anomalous nodoventricular pathways: report of 3 patients. Eur. J. Cardiol. 9: 111, 1979.PubMedGoogle Scholar
  56. 56.
    Motte G, Slama R: Les Tachycardies Ventriculaires. Edited by Laboratories Servier, Edi Conseil, Paris, 1979, p. 20.Google Scholar
  57. 57.
    Gallagher JJ, Pritchett ELC, Sealy WC, Kasell J, Wallace AG: The preexcitation syndromes. Prog. Cardiovasc. Dis. 20: 285, 1978.PubMedCrossRefGoogle Scholar
  58. 58.
    Josephson ME, Seides SF: Clinical Cardiac Electrophysiology. Lea and Febiger, Philadelphia, pp. 240, 1979.Google Scholar
  59. 59.
    Sung RJ, Styperek JL: Electrophysiologic identification of dual atrioventricular nodal pathway conduction in patients with reciprocating tachycardia using anomalous bypass tracts. Circulation 60: 1464, 1979.PubMedGoogle Scholar
  60. 60.
    Pick A: Complex ECG patterns of WolffParkinson-White syndrome. In: Cardiac Arrhythmias. Edited by OS Narula, Williams and Wilkins, Baltimore, 1979, p. 565.Google Scholar
  61. 61.
    Gallagher JJ, Smith WM, Kasell J, Benson DW, Sterba R, Grant AO: Role of Mahaim fibers in cardiac arrhythmias in man. Circulation 64: 176, 1981.PubMedCrossRefGoogle Scholar
  62. 62.
    Lerman BB, Waxman HL, Proclemer A, Josephson ME: Supraventricular tachycardia associated with nodventricular and concealed atrioventricular bypass tracts. Am. Heart J. 104: 1097, 1982.PubMedCrossRefGoogle Scholar
  63. 63.
    Reiter MJ, Smith WM, Gallagher JJ: Clinical spectrum of ventricular tachycardia with left bundle branch morphology. Am. J. Cardiol. 51: 113, 1983.PubMedCrossRefGoogle Scholar
  64. 64.
    Benditt DG, Epstein ML, Benson DW Jr: Dual accessory nodoventricular pathways: Role in paroxysmal wide QRS reciprocating tachycardia. PACE 6: 577, 1983.PubMedCrossRefGoogle Scholar
  65. 65.
    Morady F, Scheinman MM, Gonzalez R, Hess D: His-ventricular dissociation in a patient with reciprocating tachycardia and a nodoventricular bypass tract. Circulation 64: 839, 1981.CrossRefGoogle Scholar
  66. 66.
    Bardy GH, German LD, Packer DL, Coltorti F, Gallagher JJ: Mechanism of tachycardia using a nodofascicular Mahaim fiber. Am. J. Cardiol. 54: 1140, 1984.PubMedCrossRefGoogle Scholar
  67. 67.
    Bhandari A, Morady F, Shan EN, Schwartz AB, Botvinick E, Scheinman MM: Catheter-induced His bundle ablation in a patient with reentrant tachycardia associated with a nodoventricular tract. J. Am. Coll. Cardiol. 4: 611, 1984.CrossRefGoogle Scholar
  68. 68.
    Zaman L, Garcia N, Luceri RM, Castellanos A, Myerburg RJ: Ectopic left atrial rhythm that produces QRS changes in absence of WolffParkinson-White syndrome. Circulation 68: 704, 1983.CrossRefGoogle Scholar
  69. 69.
    Gallagher JJ, German LD, Broughton A, Guarnieri T, Trantham JL: Variants of the pre-excitation syndromes. In: Frontiers of Cardiac Electrophysiology. Ed. by MB Rosenbaum and MV Elizari, Martinus Nijhoff, The Hague, 1983, pp. 724–772.CrossRefGoogle Scholar
  70. 70.
    Gallagher JJ: Variants of preexcitation: Update 1984. In: Cardiac Electrophysiology and Arrhythmias. Grune and Stratton, 1984, pp. 419–433.Google Scholar
  71. 71.
    Matsuguchi H, Takeshita A, Makino N, et al: Mahaim conduction producing left axis deviation and normal QRS. Br. Heart J. 40: 902, 1978.PubMedCrossRefGoogle Scholar
  72. 72.
    Montely JM, Hanania G, Barrillon A, et al.: Fibres de Mahaim nodoventriculaires. Deux cas mis en evidence a l’exploration electrophysiologique. Arch. Mal. Coeur. 75: 801, 1982.PubMedGoogle Scholar
  73. 73.
    Rakovec P, Cijan A: Lown-Ganong-Levine syndrome associated with Mahaim nodoventricular fibres. Texas Heart Inst. J. 10: 289, 1983.Google Scholar
  74. 74.
    Garcia Civera R, Ferrero Cabedo JA, Sanjuan Manez R, et al.: Diagnostico electrofisiologico y significado clinico de la preexcitation pro fibras fasciculoventriculares, Rev. Lat. Cardiol. 4: 133, 1983.Google Scholar
  75. 75.
    Reiter MJ, Smith WM, Gallagher JJ: Clinical spectrum of ventricular tachycardia with left bundle branch morphology. Am. J. Cardiol. 51: 113, 1983.PubMedCrossRefGoogle Scholar
  76. 76.
    Rakovec P, Kranjec I, Fettich JJ, Pohar B, Fidler V: Multiple accessory pathways: a combined electrophysiological and radionuclide study. PACE 8: 60, 1985.PubMedCrossRefGoogle Scholar
  77. 77.
    Anderson RH, Becker AE, Brechenmacher C, Davies MJ, Rossi L: Ventricular preexcitation, a proposed nomenclature for its substrates. Eur. J. Cardio. 3: 27, 1975.Google Scholar
  78. 78.
    Motte G, Brenchenmacher C, Davy JM, Belhassen B: Association de fibers nodoventriculaires et atrioventriculaires a l’origine de tachycardies reciproques. Arch. Mal. Coeur. 73: 737, 1980.PubMedGoogle Scholar
  79. 79.
    Rossi L: Histopatologia del sindrome de WolffParkinson-White. Rev. Lat. Cardiol. 4: 99, 1983.Google Scholar
  80. 80.
    Rossi L: A histological survey of preexcitation and related arrhythmias. 5: 816, 1975.Google Scholar
  81. 81.
    Pahlajani DB, Miller RA, Serrato M: Patterns of atrioventricular conduction in children, Am. Heart J. 90: 165, 1975.PubMedCrossRefGoogle Scholar
  82. 82.
    Bardy GH, Fedor JM, German LD, Packer DL, Gallagher JJ: Surface electrocardiographic clues suggesting presence of a nodofascicular Mahaim fiber J. Am. Coll. Cardiol. 3: 1161, 1984.PubMedCrossRefGoogle Scholar
  83. 83.
    Smith WM, Broughton A, Reiter M, Benson DW, Grant AO, Gallagher JJ: Bystander accessory pathway during AV node reentrant tachycardia. PACE 6: 537, 1983.PubMedCrossRefGoogle Scholar
  84. 84.
    Kerr CR, Benson DW, Gallagher JJ: Role of specialized conducting fibers in the genesis of “AV nodal” reentry tachycardia. PACE 6: 171, 1983.PubMedCrossRefGoogle Scholar
  85. 85.
    Bardy GH, Packer DL, German LD, Gallagher JJ: Preexcited reciprocating tachycardia in patients with Wolff-Parkinson-White syndrome: incidence and mechanisms. Circulation 70: 377391, 1984.Google Scholar
  86. 86.
    Trantham JL, Broughton A, Guarnieri T, German LD, Gallagher JJ: (1982) Two distinct V-H intervals in tachycardia associated with nodoventricular Mahaim fibers (Abstract.) Circulation 66: I1–269, 1982.CrossRefGoogle Scholar
  87. 87.
    Klein GJ, Prystowsky EN, Pritchett ELC, Davis D, Gallagher JJ: Atypical patterns of retrograde conduction over accessory atrioventricular pathways in the Wolff-Parkinson-White syndrome. Circulation 60: 1477, 1979.PubMedGoogle Scholar
  88. 88.
    Gillette PC, Garson A Cooley DA, McNamara DG: Prolonged and decremental antegrade conduction properties in right anterior accessory connections. Wide QRS antidromic tachycardia of left bundle branch block pattern without Wolff-Parkinson-White configuration in sinus rhythm. Am. Heart J. 103: 66, 1982.PubMedCrossRefGoogle Scholar
  89. 89.
    Wellens HJJ, Durrer D: Combined conduction disturbances in two AV pathways in patients wtih Wolff-Parkinson-White syndrome. Eur. J. Cardiol. 1: 23, 1973.PubMedGoogle Scholar
  90. 90.
    Moene R, Roos J: (1973) Transient WolffParkinson-White syndrome and neonatal reciprocating tachycardia. Circulation 48: 443, 1973.Google Scholar
  91. 91.
    Sealy WC, Mikat EM: Anatomical problems with identification and interruption of posterior septal Kent bundles. Ann. Thorac. Surg. 36: 584, 1983.PubMedCrossRefGoogle Scholar
  92. 92.
    Gallagher JJ, Svenson RH, Kasell JH, German LD, Bardy GH, Broughton A, Critelli G: Catheter technique for closed chest ablation of the atrioventricular conduction system. N. Engl. J. Med. 306: 194, 1982.PubMedCrossRefGoogle Scholar
  93. 93.
    Davies MJ, Anderson RH, Becker AE: The conduction system of the heart. Butterworths, Boston, 1983.Google Scholar

Copyright information

© Martinus Nijhoff Publishing 1986

Authors and Affiliations

  • John J. Gallagher

There are no affiliations available

Personalised recommendations