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The Journal of Thoracic and Cardiovascular Surgery, Vol 80, 373-380, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JM Williams, RM Ungerleider, GK Lofland and JL Cox
Surgical management of refractory ectopic supraventricular tachycardia
arising in the left atrium requires cryoablation of the bundle of His and
insertion of a permanent ventricular pacemaker. This study was designed to
develop a technique to isolate the left atrium electrically from the
remainder of the heart, so that an artificial pacemaking system would be
unnecessary. Ten adult dogs were subjected to cardiopulmonary bypass and a
standard left atriotomy was extended anteriorly across the mitral valve
anulus between the right and left fibrous trigones. Posteriorly, the
atriotomy was extended across the mitral valve anulus just to the left of
the posterior crux and interatrial septum. The muscular interatrial fibers
accompanying the coronary sinus were cryoablated at -60 degrees C for 2
minutes. Postoperatively, all animals remained in normal sinus rhythm.
Rapid left atrial pacing did not affect the rate or rhythm of the remainder
of the heart. Preliminary hemodynamic measurements suggest that loss of the
synchronous left atrial "kick" does not significantly affect left
ventricular preload, afterload, or cardiac output. This technique offers an
alternative to the current surgical approach for management of refractory
ectopic supraventricular tachycardia arising in the left atrium.
ARTICLES
Left atrial isolation: new technique for the treatment of supraventricular arrhythmias
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