Curative surgical treatment of atrioventricular junctional re-entrant tachycardia by perinodal dissection

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Abstract
The medical treatment of an atrioventricular junctional (AV-nodal) re-entrant tachycardia (AVJRT) is often ineffective due to failure of responseor significant side effects. Recently, reports of curative surgicalprocedures using either dissection or cryocoagulation in the AV node areawith preservation of normal AV conduction, have been published withexcellent short term results in small series. The present paper describesour experience of surgical treatment using the dissection method in fivepatients. In all patients, AVJRT with short retrograde conduction intervalswas diagnosed during the pre- and intraoperative electrophysiologicalstudies. The earliest site of atrial activation during tachycardia was seenclose to the triangle of Koch, antero-medially to the AV node. Electiveopen heart surgery was performed and after cold cardioplegic arrest, theright atrial endocardium was incised and the perinodal atrium carefullydisconnected from the AV node. After surgery, a tachycardia could not beinduced in any of the patients. In a follow-up period of 14-29 months, allpatients have been free of symptoms without antiarrhythmic drugs. Earlyelectrophysiological evaluation of patients with supraventriculartachycardia is advocated and in patients with medically refractory AVJRT,surgery is recommended.
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