Author + information
- Received December 12, 1988
- Revision received July 11, 1989
- Accepted July 26, 1989
- Published online December 1, 1989.
- Mark A. McGuire, MB, BS,
- David C. Johnson, FRACS,
- Graham R. Nunn, FRACS,
- Teresa Yung, FRACA, FRCPS(C),
- John B. Uther, MD, FRACP and
- David L. Ross, FRACP, FACC∗
- ↵∗Address for reprints: David L. Ross, MD, Cardiology Unit, Westmead Hospital, Westmead, NSW 2145, Australia.
Eighteen adult patients with atrial tachycardia refractory to treatment with a mean of four drugs underwent attempted surgical cure. Atrial tachycardia originated in the right atrium in 17 patients and the left atrium in 1 patient. Tachycardia could be reproducibly induced and terminated by atrial extrastimuli or atrial pacing in 8 patients (44%). Resection of the arrhythmogenic area was performed in 16 patients (89%), and an isolation procedure was performed in 1 patient. In seven cases (39%), the area of isolation or excision included the sinoatrial node. One patient underwent His bundle section because the arrhythmogenic region was too close to the atrioventricular (AV) conduction system to enable resection.
The mean duration of clinical follow-up was 56 ± 34 months. Clinical tachycardia recurred in five patients (28%), but in two patients it did not recur until >1 year after surgery. A permanent pacemaker was implanted in 3 (18%) of the 17 patients whose His-Purkinje system was left intact. One other patient had required permanent pacing before surgery. Only one of the seven patients undergoing sinoatrial node resection or isolation required permanent pacing for symptomatic bradycardia. Apart from the requirement for permanent pacing, no significant complications occurred.
Surgical therapy for atrialtachycardia is a safe procedure, but the rate of cure appears to be less than that of supraventricular tachycardias associated with accessory AV connections. Excision or isolation of the sinoatrial node does not necessitate permanent pacing in most patients.
☆ Dr. McGuire is supported by a grant from the National Health and Medical Research Council of Australia, Phillip, Australian Capital Territory, Australia.
- Received December 12, 1988.
- Revision received July 11, 1989.
- Accepted July 26, 1989.