[Fulguration of the bundle of His. Description of 3 new cases].
With the purpose to call attention to the clinical utility of fulguration of the His bundle (a therapeutic procedure somewhat neglected in Italy) 3 new cases are presented. All patients had a long history of supraventricular tachyarrhythmias refractory to conventional treatment. Patients 1 and 2, in whom surgical correction of tetralogy of Fallot and mitral valve replacement, respectively, had been performed several years before, had chronic atrial tachycardia with congestive heart failure. Patient 3 suffered from persistent atrial flutter, in the absence of demonstrable organic heart disease. Three shocks of 320 J were necessary to induce complete AV block in patient 1 and 2. In patient 3, a single discharge (320 J) resulted in interruption of AV conduction. Twenty-four hours after the procedure, a rate-responsive ventricular pacemaker was implanted in all patients. The success of the procedure was confirmed 3 months later, during transitory pacemaker inhibition. Patients 1 and 3 exhibited atrial tachycardia and atrial flutter, respectively, but complete AV block was still present, with junctional escape rhythm at a rate of 40 and 45 b/min; in patient 2 atrial tachycardia with high degree AV block, and a mean ventricular rate of 75 b/min, were observed. Refinement of transcatheter ablative techniques is desirable. However, even in the present status, catheter ablation of the His bundle is an effective, low-risk procedure for patients with refractory supraventricular tachyarrhythmias.
Critelli
G
G
II Cattedra di Malattie dell'Apparato Cardiovascolare, Istituto di Cardiochirurgia Università degli Studi La Sapienza, Roma.
Pulignano
G
G
Patruno
N
N
Urbani
P
P
Ambrosini
M
M
Greco
C
C
Reale
A
A
D000328:Adult; D002036:Bundle of His / Q000601:surgery*; D004562:Electrocardiography; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000601:surgery*
La folgorazione del fascio di His. Descrizione di 3 nuovi casi.