The Journal of Thoracic and Cardiovascular Surgery, Vol 85, 746-751, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Surgical treatment of the two types of tachycardia caused by Kent bundles with only retrograde function
WC Sealy
Accessory pathways of atrioventricular (AV) conduction of the Kent type,
with only retrograde conduction, have been implicated in from 25% to 40% of
reentry supraventricular tachycardias. In the 22 patients with Kent bundles
of this type, the subject of this report, two different kinds of reentry
tachycardia were found. Sixteen patients had a narrow QRS reentry
paroxysmal tachycardia similar to that found with the usual bidirectional
pathway. Their Kent bundles were located in the following areas: posterior
septum, two; anterior septum, two; right free wall, one; and left free
wall, 11. The pathways had the electrophysiological characteristics of
working myocardium. A second and unusual group of six patients had a
tachycardia described by Coumel as permanent or incessant junctional
reciprocating tachycardia. The pathways were all in the posterior septal
area. The electrophysiological characteristics of the Kent bundles were
slow conduction with decremental properties similar to the AV node.
Operation was successful in correcting both types of tachycardias. His
bundle interruption was used as an elective procedure in two and after
failure to divide the Kent bundle in two others. Kent bundle interruption
was successful in the remaining 18 patients. Some of the
electrophysiological aspects of special surgical interest are discussed.
