The Annals of Thoracic Surgery, Vol 32, 429-438, Copyright © 1981 by The Society of Thoracic Surgeons
His bundle interruption for control of inappropriate ventricular responses to atrial arrhythmias
WC Sealy, JJ Gallagher and J Kasell
Forty-two patients with life-threatening or disabling atrial arrhythmias
are discussed. Fifteen had Kent bundles as the basis for the reentry
tachycardia, while 27 had arrhythmias that originated in or above the
atrioventricular (AV) node. Nineteen of the latter had an AV node that
conducted atrial impulses rapidly to the ventricle. These patients were
classified as having enhanced conduction through the AV node, a diagnosis
based on clinical and electrophysiological studies. Initially, the
technique employed for His bundle interruption was, either separate or in
combination, blind suture, electrocauterization, and incision of the septal
portion of the right atrium. The technique later adopted was sharp division
of the atrial septum at its attachment to the right fibrous trigone.
Cryothermia was used in 31 patients. There were four failures. In the group
in whom sharp division was used. there were two failures among 11 patients.
Two patients, however, had to have a second operation. Following AV
node-His bundle interruption, a junctional rhythm resulted and a pacemaker
was always installed. Our studies indicate that interruption of atrial to
ventricular conduction is a satisfactory operation for atrial arrhythmias
that are disabling or life threatening and that are refractory to vigorous
medical therapy. Cryothermic ablation is the preferable technique. However,
if this is not successful, then division is required of the AV nod-His
bundle junction by interruption of the insertion of the atrial septum into
the right fibrous trigone.
