[Experience with ablation of the bundle of His using electrical discharge]

Ablation of the bundle of His by an electric discharge was made in 10 patients (average age 64 years, range 48-80) unsuccessfully treated with 3-14 antiarrhythmic drugs or their combinations (average 8.7) on account of supraventricular tachycardia occurring repeatedly for 3-44 years (average 12.5 years). By means of a bipolar electrode inserted into the area of the bundle of His a nonsynchronized defibrillation discharge with a mean energy of 323 J (40-380) was administered. On average 2.9 discharges were used (1-9) per patient, in 1-3 sessions. The patients were followed up for a period of 15.3 months (10-19). Permanent complete a-v block was achieved in 6 patients, the remaining 4 patients are also free from complaints with have antiarrhythmic treatment. To all patients a pacemaker was implanted, four times "physiological" stimulation was used. One month after the operation the authors observed once the development of a transient phatic disorder and once the slow development of cardiac tamponade in conjunction with anticoagulant treatment, resolved by pericardial puncture. Ablation of the bundle of His by a defibrillation discharge is thus in carefully selected patients a highly effective method of treatment of stubborn supraventricular tachycardias.