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Catheter ablation of the atrioventricular junction in patients with refractory atrial arrhythmias
M A Hood1, W M Smith, M C Robinson
1Cardiothoracic Surgical Unit, Green Lane Hospital, Auckland.
Insights
Closed chest ablation for atrial arrhythmias was successful in most patients, but open surgical ablation was also used. This procedure should be reserved for patients with refractory symptomatic atrial arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial arrhythmias can be refractory to medical treatment.
- Surgical ablation and permanent pacemaker implantation are treatment options for severe cases.
- Closed-chest ablation offers a less invasive approach.
Purpose of the Study:
- To evaluate the efficacy and safety of closed-chest ablation for refractory symptomatic atrial arrhythmias.
- To compare outcomes with open surgical ablation.
Main Methods:
- Twelve patients with refractory symptomatic atrial arrhythmias were assessed.
- Closed-chest ablation with permanent pacemaker implantation was performed in 11 patients.
- Three patients underwent open surgical ablation.
Main Results:
- Closed-chest ablation was successful in 9 out of 11 attempted procedures.
- Two patients required repeat ablative procedures.
- Complications were minor in three patients.
Conclusions:
- Closed-chest ablation is a viable option for selected patients with refractory symptomatic atrial arrhythmias.
- Due to potential complications like ventricular arrhythmias, closed-chest ablation should be reserved for patients unresponsive to maximal medical therapy.
Abstract:
Twelve patients with refractory symptomatic atrial arrhythmias were evaluated for closed chest ablation and permanent pacemaker implantation. This was successful in nine of the 11 patients in whom ablation was attempted. Two of these nine patients required two separate ablative procedures. Three patients underwent open surgical ablation. Electrical ablation had failed in two of these patients and had not been undertaken in the remaining patient (inadequate His recording). The mean His amplitude and delivered energy levels were not significantly different between the two groups. Complications occurred in three patients and were minor. Because ventricular arrhythmias and late sudden death are recognised complications in a minority of patients undergoing closed chest ablation of the A-V junction it should be restricted to patients with symptomatic atrial arrhythmias who have failed maximal medical treatment.