title: Curative surgical treatment of atrioventricular junctional re-entrant tachycardia by perinodal dissection.
abstract: 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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, University Hospital Arhus, Denmark.
authors.forename: P K
authors.initials: PK
authors.lastname: Paulsen
authors.forename: P E
authors.initials: PE
authors.lastname: Thomsen
authors.forename: P T
authors.initials: PT
authors.lastname: Mortensen
authors.forename: O
authors.initials: O
authors.lastname: Albrechtsen
mesh_terms: D000293:Adolescent; D000328:Adult; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery*; D002036:Bundle of His / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D002648:Child; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery*; D013617:Tachycardia, Supraventricular / Q000601:surgery*