Document Detail


Alteration of antegrade atrioventricular conduction by cryoablation of peri-atrioventricular nodal tissue. Implications for the surgical treatment of atrioventricular nodal reentry tachycardia.
MedLine Citation:
PMID:  6738104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Paroxysmal supraventricular tachycardia due to atrioventricular nodal reentry is a common arrhythmia that usually responds to medical therapy. When atrioventricular nodal reentry tachycardia is refractory to medical therapy, surgical cryoablation or endocardial catheter ablation of the His bundle has been employed to protect the ventricles from the tachycardia. However, these techniques necessitate implantation of a permanent ventricular pacemaker. The purpose of the present study was to develop a cryosurgical procedure capable of ablating the anatomic-electrophysiological substrate of atrioventricular nodal reentry by modifying, rather than ablating, atrioventricular conduction. Thirty-three adult mongrel dogs underwent either the cryosurgical procedure (n = 23) or a sham operation (n = 10). All animals were restudied immediately postoperatively (acute cryosurgery group [n = 12) and sham group [n = 10]), and 11 animals (chronic cryosurgery group) subjected to cryosurgery were studied 14 weeks postoperatively. Decremental atrial pacing and programmed premature atrial stimulation protocols were utilized to determine atrioventricular nodal conduction time, atrioventricular nodal refractory period, and the Wenckebach point before and after operation in all animals. No electrophysiological alterations were noted in the sham-operated group. In the cryosurgery groups, atrioventricular nodal conduction time, functional refractory period of the atrioventricular node, and the Wenckebach point were all significantly prolonged in the immediate postoperative period, but only atrioventricular nodal conduction time remained prolonged 14 weeks postoperatively. The potential application of the new cryosurgical procedure for the treatment of atrioventricular nodal reentry tachycardia was demonstrated in three animals that exhibited dual atrioventricular nodal conduction preoperatively but had monophasic atrioventricular conduction curves postoperatively. The results in these animals documented that the cryosurgical procedure is capable of ablating the anatomic-electrophysiological substrate necessary for atrioventricular nodal reentry tachycardia.
Authors:
W L Holman; M Ikeshita; J G Lease; T B Ferguson; G K Lofland; J L Cox
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  88     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1984 Jul 
Date Detail:
Created Date:  1984-08-01     Completed Date:  1984-08-01     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  67-75     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Animals
Atrioventricular Node / physiopathology,  surgery*
Bundle of His / surgery
Cryosurgery / methods*
Dogs
Electrocardiography
Electrophysiology
Follow-Up Studies
Heart Atria / physiopathology
Heart Conduction System / surgery*
Tachycardia / surgery*
Time Factors
Grant Support
ID/Acronym/Agency:
HL06120/HL/NHLBI NIH HHS; HL06418/HL/NHLBI NIH HHS; HL25983/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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