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[Fulguration of the bundle of His. An explanation based on 128 consecutive personal cases]
1Service de Cardiologie, Hôpital du Haut-Lévêque, Pessac.
Insights
Fulguration of the bundle of His effectively treats refractory atrial arrhythmias by slowing atrioventricular conduction. This procedure, with rare complications, allows most patients to resume normal activity via ventricular stimulation.
Area of Science:
- Cardiology
- Electrophysiology
Context:
- Refractory atrial arrhythmias significantly impact patient quality of life.
- Atrioventricular conduction abnormalities necessitate effective treatment strategies.
Purpose:
- To evaluate the efficacy and safety of His bundle fulguration for managing refractory atrial arrhythmias.
- To present a simplified technique for His bundle fulguration using Josephson's catheter.
Summary:
- Fulguration of the bundle of His was performed on 128 patients.
- At 3 months, 80% achieved 3rd-degree atrioventricular block, 10% had 1st-degree block, and 10% experienced failure.
- Immediate complications were rare and benign; late complications depended on cardiac stimulation type.
Impact:
- His bundle fulguration provides a viable treatment option for complex atrial arrhythmias.
- Ventricular stimulation post-procedure enables most patients to return to normal activities.
Abstract:
Fulguration of the bundle of His consists is interrupting or markedly slow-down the atrio-ventricular conduction, in order to suppress or markedly decrease the symptoms related to refractory atrial arrhythmias. With a consecutive series of 128 cases, it is possible to specify the main indications and present a simplified technique, using Josephson's catheter. At 3 months, the results are as follows: 3rd degree atrio-ventricular block in 80 p. cent of the cases, 1st degree atrio-ventricular block in 10 p. cent, with failure in 10 p. cent of the cases. The immediate complications are rare and benign. Late complications are essentially related to the type of cardiac stimulation offered to the patient. The ventricular stimulation with dependent frequency (particularly on ventilation), enables most patients to return to a normal activity.