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[Fulguration of the bundle of His. Description of 3 new cases]
G Critelli1, G Pulignano, N Patruno
1II Cattedra di Malattie dell'Apparato Cardiovascolare, Istituto di Cardiochirurgia Università degli Studi La Sapienza, Roma.
Insights
Fulguration of the His bundle effectively treats refractory supraventricular tachyarrhythmias. This low-risk procedure, involving His bundle ablation, offers a viable option for patients unresponsive to conventional therapies.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Supraventricular tachyarrhythmias can be refractory to standard treatments.
- Fulguration of the His bundle is an underutilized therapeutic option.
Observation:
- Three cases of refractory supraventricular tachyarrhythmias (atrial tachycardia, atrial flutter) are presented.
- Patients had prior cardiac surgeries or no organic heart disease.
- Fulguration of the His bundle was performed using electrical shocks.
Findings:
- Complete atrioventricular (AV) block was successfully induced in all patients.
- Patients received rate-responsive ventricular pacemakers post-procedure.
- Follow-up confirmed persistent AV block and controlled ventricular rates, indicating procedural success.
Implications:
- Catheter ablation of the His bundle is an effective and low-risk treatment for refractory supraventricular tachyarrhythmias.
- Further refinement of transcatheter ablative techniques is warranted.
- This procedure provides a valuable therapeutic avenue for complex cardiac arrhythmia cases.
Abstract:
With the purpose to call attention to the clinical utility of fulguration of the His bundle (a therapeutic procedure somewhat neglected in Italy) 3 new cases are presented. All patients had a long history of supraventricular tachyarrhythmias refractory to conventional treatment. Patients 1 and 2, in whom surgical correction of tetralogy of Fallot and mitral valve replacement, respectively, had been performed several years before, had chronic atrial tachycardia with congestive heart failure. Patient 3 suffered from persistent atrial flutter, in the absence of demonstrable organic heart disease. Three shocks of 320 J were necessary to induce complete AV block in patient 1 and 2. In patient 3, a single discharge (320 J) resulted in interruption of AV conduction. Twenty-four hours after the procedure, a rate-responsive ventricular pacemaker was implanted in all patients. The success of the procedure was confirmed 3 months later, during transitory pacemaker inhibition. Patients 1 and 3 exhibited atrial tachycardia and atrial flutter, respectively, but complete AV block was still present, with junctional escape rhythm at a rate of 40 and 45 b/min; in patient 2 atrial tachycardia with high degree AV block, and a mean ventricular rate of 75 b/min, were observed. Refinement of transcatheter ablative techniques is desirable. However, even in the present status, catheter ablation of the His bundle is an effective, low-risk procedure for patients with refractory supraventricular tachyarrhythmias.