Latent Mahaim fiber as a cause of antidromic reciprocating tachycardia: Recognition and successful radiofrequency ablation

The term "Mahaim fiber" usually is applied to an atriofascicular fiber that inserts distally into the right bundle branch and forms the anterograde limb of a reciprocating tachycardia. One of the features that has been used to describe the physiology of Mahaim fibers is the presence of anterograde preexcitation. We describe two patients who had a clinical tachycardia consistent with a "Mahaim tachycardia" in whom there was no evidence or minimal evidence of anterograde preexcitation during sinus rhythm or atrial pacing. In both patients, the tachycardia was rendered noninducible by radiofrequency ablation at the site of Mahaim potentials at the tricuspid annulus, and a long-term cure was achieved. This is the first description of a "latent Mahaim fiber" that does not cause preexcitation but which can support antidromic reciprocating tachycardia.