Spontaneous automaticity occurred in 12.5% of our Mahaim patients and may trigger antidromic tachycardia. Spontaneous automaticity, which is not seen in rapidly conducting accessory pathways, is another argument for the presence of an AV nodal-like structure in Mahaim fibers.

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Implantable cardioverter defibrillator (ICD) remains an effective therapeutic option to prevent sudden death, with a favorable profile in the natural history of cardiac channelopathies (CCh), 1 which are inherited cardiac ion channels disorders associated with potential ventricular arrhythmias and sudden death in the presence of a structurally normal heart. 2,3 The most prevalent CCh are congenital long QT syndrome (LQTS), Brugada syndrome (BrS), and catecholaminergic polymorphic ventricular tachycardia (CPVT), which account for approximately onethird of unexplained sudden deaths. 4,5 The treatment goal of CCh is to avoid arrhythmias and sudden death, which still remains a challenge. In cases of