Operative therapy of atrioventricular node reentry and results of an anatomically guided procedure
Identifieur interne : 004A92 ( Main/Exploration ); précédent : 004A91; suivant : 004A93Operative therapy of atrioventricular node reentry and results of an anatomically guided procedure
Auteurs : Osamu Fujimura [Canada] ; Gerard M. Guiraudon [Canada] ; Raymond Yee [Canada] ; Arjun D. Sharma [Canada] ; George J. Klein [Canada]Source :
- The American Journal of Cardiology [ 0002-9149 ] ; 1989.
Abstract
Operative therapy for atrioventricular (AV) node reentrant tachycardia consisting of dissection guided by anatomic landmarks is described. Of the 21 patients studied, 17 had the common type (“slow-fast”) and 4 had the uncommon type (“fast-slow”) of AV node reentry. Under normothermic cardiopulmonary bypass, perinodal dissection was performed guided by anatomic landmarks: the atrial membranous septum, posterior superior process of the left ventricle, tendon of Todaro and os of the coronary sinus. There were no deaths or major complications. Seven to 10 days postoperatively, all patients had normal AV conduction except for one who continued to have AV node Wenckebach-type block. Postoperatively, the shortest cycle length capable of 1:1 conduction over the AV node changed from 323 ± 66 to 421 ± 90 ms (p < 0.0001) anterogradely and from 330 ± 86 to 449 ± 164 ms (p = 0.004) retrogradely. Anterograde effective refractory period of the AV node prolonged from 264 ± 49 to 358 ± 107 ms (p = 0.012). Discontinuous AV conduction curves were no longer seen in 14 of 17 patients and 5 patients lost retrograde conduction. During follow-up (14.8 ± 8.2 months), 19 patients have been free of arrhythmia without medication. Two patients required a second operation for recurrent tachycardia with success. No patient required a permanent pacemaker. These data show that operative therapy of AV node reentrant tachycardia can be guided by anatomic landmarks. Successful cure of tachycardia with perinodal dissection while preserving AV node conduction supports the view that the reentrant circuit is, at least in part, perinodal.
Url:
DOI: 10.1016/0002-9149(89)90576-6
Affiliations:
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Guiraudon</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Departments of Medicine and Surgery, University of Western Ontario, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Departments of Medicine and Surgery, University of Western Ontario, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Sharma, Arjun D" sort="Sharma, Arjun D" uniqKey="Sharma A" first="Arjun D." last="Sharma">Arjun D. Sharma</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Departments of Medicine and Surgery, University of Western Ontario, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Departments of Medicine and Surgery, University of Western Ontario, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="ISSN">0002-9149</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1989">1989</date><biblScope unit="volume">64</biblScope><biblScope unit="issue">19</biblScope><biblScope unit="page" from="1327">1327</biblScope><biblScope unit="page" to="1332">1332</biblScope></imprint><idno type="ISSN">0002-9149</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9149</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Operative therapy for atrioventricular (AV) node reentrant tachycardia consisting of dissection guided by anatomic landmarks is described. Of the 21 patients studied, 17 had the common type (“slow-fast”) and 4 had the uncommon type (“fast-slow”) of AV node reentry. Under normothermic cardiopulmonary bypass, perinodal dissection was performed guided by anatomic landmarks: the atrial membranous septum, posterior superior process of the left ventricle, tendon of Todaro and os of the coronary sinus. There were no deaths or major complications. Seven to 10 days postoperatively, all patients had normal AV conduction except for one who continued to have AV node Wenckebach-type block. Postoperatively, the shortest cycle length capable of 1:1 conduction over the AV node changed from 323 ± 66 to 421 ± 90 ms (p < 0.0001) anterogradely and from 330 ± 86 to 449 ± 164 ms (p = 0.004) retrogradely. Anterograde effective refractory period of the AV node prolonged from 264 ± 49 to 358 ± 107 ms (p = 0.012). Discontinuous AV conduction curves were no longer seen in 14 of 17 patients and 5 patients lost retrograde conduction. During follow-up (14.8 ± 8.2 months), 19 patients have been free of arrhythmia without medication. Two patients required a second operation for recurrent tachycardia with success. No patient required a permanent pacemaker. These data show that operative therapy of AV node reentrant tachycardia can be guided by anatomic landmarks. Successful cure of tachycardia with perinodal dissection while preserving AV node conduction supports the view that the reentrant circuit is, at least in part, perinodal.</div></front></TEI><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Fujimura, Osamu" sort="Fujimura, Osamu" uniqKey="Fujimura O" first="Osamu" last="Fujimura">Osamu Fujimura</name></noRegion><name sortKey="Guiraudon, Gerard M" sort="Guiraudon, Gerard M" uniqKey="Guiraudon G" first="Gerard M." last="Guiraudon">Gerard M. Guiraudon</name><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><name sortKey="Sharma, Arjun D" sort="Sharma, Arjun D" uniqKey="Sharma A" first="Arjun D." last="Sharma">Arjun D. Sharma</name><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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