Surface electrocardiographic clues suggesting presence of a nodofascicular mahaim fiber

Gust H. Bardy, John M. Fedor, Lawrence D. German, Douglas L. Packer, John J. Gallagher

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

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 iachycardia, 34 with supraventricular tachycardia and aberrant conduction over the His-Purkinje systent, 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 no- dofascicular fiber: cycle length between 220 and 450 ms, QRS axis of 0 to −75°, 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 no-dofascicular fiber did. It is concluded that analysis of the surface electrocardiogram during tachycardia may suggest the presence of a nodofascicular fiber.

Original languageEnglish (US)
Pages (from-to)1161-1168
Number of pages8
JournalJournal of the American College of Cardiology
Volume3
Issue number5
DOIs
StatePublished - 1984

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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