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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 440-449, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JL Cox, TB Ferguson Jr, BD Lindsay and ME Cain
Atrioventricular node reentry tachycardia is the most common cause of
paroxysmal supraventricular tachycardia. Available nonpharmacologic
therapies include (1) catheter ablation or cryosurgical ablation of the His
bundle and insertion of a permanent pacemaker and (2) surgical dissection
around the atrioventricular node or discrete cryosurgery of the perinodal
tissues, in an attempt to divide or ablate only one of the dual
atrioventricular node conduction pathways responsible for the tachycardia
while leaving the other intact. This report describes 23 consecutive
patients who underwent the discrete cryosurgical procedure between August
13, 1982, and March 16, 1989. The first patient in this series, a
38-year-old woman, is the first patient in whom refractory atrioventricular
node reentry tachycardia was cured surgically by a procedure designed to
treat this arrhythmia. The ages of the 13 female and 10 male patients
ranged from 12 to 56 years with an average age of 29 years. Fourteen of the
23 patients (61%) had the Wolff-Parkinson- White syndrome. Other associated
arrhythmias included atrial flutter/fibrillation (n = 2), right atrial
reentrant tachycardia (n = 1), junctional tachycardia (n = 1), and a Mahaim
fiber (n = 1). Associated anatomic abnormalities included Ebstein's anomaly
in two patients and a large right atrial aneurysm in one patient. The
perinodal cryosurgical procedure was performed through a right atriotomy in
the normothermic beating heart. Multiple 3 mm diameter cryolesions were
placed around the borders of the triangle of Koch on the lower right atrial
septum to alter the input pathways of the atrioventricular node. There were
no operative deaths in this series of patients. Postoperatively, all 23
patients had normal atrioventricular conduction, and no heart block has
occurred in any patients during the follow-up period. All patients have
remained free of atrioventricular node reentry tachycardia (and of the
Wolff-Parkinson-White syndrome) and none has required postoperative
antiarrhythmic drugs for either of these arrhythmias. We consider this
simple, safe, easily performed, and uniformly successful operation to be
the procedure of choice for the treatment of medically refractory
atrioventricular node reentry tachycardia.
ARTICLES
Perinodal cryosurgery for atrioventricular node reentry tachycardia in 23 patients
Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Mo. 63110.
This article has been cited by other articles:
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  A. Khositseth, G. K. Danielson, J. A. Dearani, T. M. Munger, and C. J. Porter Supraventricular tachyarrhythmias in Ebstein anomaly: Management and outcome J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 826 - 833. [Abstract] [Full Text] [PDF]
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 G.P. Kimman, N.M. van Hemel, E.R. Jessurun, P.F.H.M. van Dessel, J.C. Kelder, J.J.A.M.T. Defauw, and G.M. Guiraudon Comparison of late results of surgical or radiofrequency catheter modification of the atrioventricular node for atrioventricular nodal reentrant tachycardia Eur. Heart J., April 1, 1999; 20(7): 527 - 534. [Abstract] [PDF]
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 M. Ikeshita, S. Yamauchi, T. Nitta, and T. Shoji Continuous and Stable Recording of the His Bundle Electrogram During Open Heart Operations Ann. Thorac. Surg., February 1, 1995; 59(2): 535 - 537. [Abstract] [Full Text]
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 L. I. Ganz and P. L. Friedman Supraventricular Tachycardia N. Engl. J. Med., January 19, 1995; 332(3): 162 - 173. [Full Text] [PDF]
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