The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 61-67, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Cryosurgical ablation of atrioventricular junction without extracorporeal circulation
J Bredikis
A closed technique, using thoracotomy without cardiopulmonary bypass and
atriotomy, for cryosurgical ablation of the atrioventricular node- His
bundle junction is described. The technique was used in 34 patients
selected from among 136 patients with disabling supraventricular
tachyarrhythmias refractory to drug therapy in whom atrioventricular block
was produced. After thoracotomy, four methods can be used to determine the
site of cryoinstrument application: palpation of the internal anatomic
landmarks, a "mechanical test," use of a cryoprobe, or recording of the His
bundle electrogram. The cryoprocedure lasts 160 to 180 seconds at
temperatures of -60 degrees to -80 degrees C and is repeated once or twice.
Complete atrioventricular block was induced in 29 of the 34 patients.
Paroxysmal tachycardia was terminated in 31. There were no operative
deaths. The frequency of surgical complications was nearly three times
lower than in the group of 77 patients subjected to open cryodestruction of
the atrioventricular junction, and the length of hospital stay after the
operation was an average of 4.7 days shorter. The follow-up for up to 6.5
years (mean 34 months) failed to show postoperative paroxysmal tachycardia
or tachyarrhythmia in 31 patients. In my opinion, this rather safe method
for ablation of the atrioventricular junction could be more widely used,
especially if there are contraindications for extracorporeal circulation or
if transvenous catheter ablation has failed.
