Surgery of tachyarrhythmia: intracardiac closed heart cryoablation

Closed heart surgery without the use of cardiopulmonary bypass (CPB) is one of the trends of surgical treatment of tachyarrhythmias. Having rich experience of epicardial cryoablation, the authors introduced the original technique of intracardiac cryoablation. They have demonstrated the feasibility of creation of complete AV block in patients with supraventricular tachycardias by AV node-His-bundle cryoablation, elimination of AV junctional ("nodal") tachycardia by perinodal cryoablation, cryoablation of septal and paraseptal left posterior AV accessory pathways and ectopic foci in atrial septum, complete or partial cryoisolation or cryofragmentation of the atria in patients with atrial flutter and/or fibrillation, and cryoablation or arrhythmogenic zones in ventricles. Good results (arrhythmia-free patients) were obtained in 82%-100%. Cryoablation on the closed heart without the use of CPB has the following advantages: (a) the possibility of continuous monitoring of cardiac electrical activity during the operation; (b) ablation efficacy control; and (c) diminished trauma and little risk of surgical intervention.