Author + information
- Received September 19, 1986
- Revision received December 31, 1986
- Accepted January 9, 1987
- Published online August 1, 1987.
- Tibor S. Szabo, MD1,
- Douglas L. Jones, PhD1,
- Gerard M. Guiraudon, MD, FACC1,
- Max F. Rattes, MD1,
- D. Garth Perkins, MD1,
- Arjun D. Sharma, MD, FACC1 and
- George J. Klein, MD, FACC*,1
- ↵*Address for reprints: George J. Klein, MD, Cardiac Investigation Unit, University Hospital, PO Box 5339, Station A, London, Ontario, Canada N6A 5A5.
Intraoperative modification of the atrioventricular (AV) node to prolong refractoriness could be an alternative to His bundle ablation in patients with refractory supraventricular arrhythmias. It was postulated that a cryosurgical lesion at the posterior interatrial septum in the closed heart could achieve this. An electrophysiologic study was performed in anesthetized dogs. The AV fat pad was mobilized to expose the posteroseptal region. A cryoprobe cooled to 0 to −10°C was moved in the exposed region until reversible AV block indicated proximity of the AV node. The probe was then cooled to −70°C for 30 seconds.
Four weeks later, five dogs had a favorable result with a mean prolongation of Wenckebach cycle length of 45 ± 7% (p < 0.05). Two dogs had complete heart block. Decreased (one dog) or increased (one dog) duration of freezing resulted in no change and complete heart block, respectively. Histologic examination verified partial damage to the AV node with preservation of the His bundle.
Thus, 1) controlled cryoinjury to modify AV node function is feasible in the closed heart; 2) preservation of AV conduction provides an advantage over His bundle ablation.
- Received September 19, 1986.
- Revision received December 31, 1986.
- Accepted January 9, 1987.
- American College of Cardiology Foundation