European Journal of Cardio-Thoracic Surgery, Vol 3, 397-400, Copyright © 1989 by European Association for Cardio-thoracic Surgery
Curative surgical treatment of atrioventricular junctional re-entrant tachycardia by perinodal dissection
PK Paulsen, PE Thomsen, PT Mortensen and O Albrechtsen
Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, University Hospital Arhus, Denmark.
The medical treatment of an atrioventricular junctional (AV-nodal) re-
entrant tachycardia (AVJRT) is often ineffective due to failure of response
or significant side effects. Recently, reports of curative surgical
procedures using either dissection or cryocoagulation in the AV node area
with preservation of normal AV conduction, have been published with
excellent short term results in small series. The present paper describes
our experience of surgical treatment using the dissection method in five
patients. In all patients, AVJRT with short retrograde conduction intervals
was diagnosed during the pre- and intraoperative electrophysiological
studies. The earliest site of atrial activation during tachycardia was seen
close to the triangle of Koch, antero-medially to the AV node. Elective
open heart surgery was performed and after cold cardioplegic arrest, the
right atrial endocardium was incised and the perinodal atrium carefully
disconnected from the AV node. After surgery, a tachycardia could not be
induced in any of the patients. In a follow-up period of 14-29 months, all
patients have been free of symptoms without antiarrhythmic drugs. Early
electrophysiological evaluation of patients with supraventricular
tachycardia is advocated and in patients with medically refractory AVJRT,
surgery is recommended.
