The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1035-1044, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Surgery for atrioventricular node reentry tachycardia. Results with surgical skeletonization of the atrioventricular node and discrete perinodal cryosurgery
Y Mahomed, RD King, D Zipes, WM Miles, LS Klein and JW Brown
Department of Surgery, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202.
Surgical treatment options for interruption of atrioventricular node
reentrant tachycardia include (1) skeletonization of the atrioventricular
node by dissecting it from most of its atrial inputs and (2) discrete
cryosurgery of the perinodal tissues by applying a series of sequential
cryolesions to the atrial tissues immediately adjacent to the
atrioventricular node. Both these techniques attempt to interrupt one of
the dual atrioventricular node conduction pathways while preserving the
other. This report describes 17 consecutive patients who underwent surgical
treatment, 10 patients with skeletonization of the atrioventricular node
and seven patients with discrete perinodal cryosurgery. There were 10
female and seven male patients and their ages ranged from 28 to 56 years
(mean 38). Two of the 17 patients had Wolff-Parkinson-White syndrome and
their accessory pathways were interrupted before the atrioventricular nodal
reentrant tachycardia was ablated. All the procedures were performed in a
normothermic beating heart while atrioventricular conduction was monitored
closely. In the skeletonization technique, the right atrial septum was
mobilized and the atrioventricular node exposed anterior to the tendon of
the Todaro. The perinodal cryosurgical procedure was also performed through
a right atriotomy and a series of sequential 3 mm cryolesions were placed
around the borders of the triangle of Koch on the inferior right atrial
septum. There were no operative deaths. Two patients who underwent the
skeletonization operation had heart block necessitating pacemaker therapy.
At postoperative electrophysiologic study, no echoes or atrioventricular
nodal reentrant tachycardia were inducible in any of the 17 patients. All
patients have remained free of arrhythmia recurrence and have required no
antiarrhythmic therapy after a follow-up of 5 to 28 months (mean 14). In
conclusion, both atrioventricular node skeletonization and perinodal
cryosurgery successfully ablate atrioventricular nodal reentrant
tachycardia; however, perinodal cryosurgery appears to be safer in avoiding
heart block, is more easily performed, and is our procedure of choice for
the management of medically refractory atrioventricular nodal reentrant
tachycardia.
