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[Successful surgical treatment of atrial tachyarrhythmias]
Insights
Surgical cryocoagulation effectively treated drug-resistant ectopic atrial tachycardia and atrial flutter (AF). Procedures preserved atrioventricular (AV) conduction, offering a successful alternative for managing complex arrhythmias.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Minimally Invasive Surgery
Background:
- Drug-resistant ectopic atrial tachycardia and atrial flutter (AF) pose significant management challenges.
- Conventional treatments may be ineffective for certain complex cardiac arrhythmias.
- Surgical intervention offers a potential alternative for refractory cases.
Observation:
- Three patients with ectopic atrial tachycardia underwent surgical removal of the ectopic focus and cryocoagulation without cardiopulmonary bypass.
- Two patients with atrial flutter (AF) were treated with cryosurgical ablation.
- One AF patient initially underwent ablation near the coronary sinus, requiring a second procedure near the AV node and His bundle.
Findings:
- All three patients with ectopic atrial tachycardia achieved sustained sinus rhythm post-surgery.
- Cryosurgical ablation around the AV node and His bundle prevented AF in one patient without causing AV block.
- In the second AF patient, cryoablation around the AV node and His bundle reduced heart rate and necessitated pacemaker implantation, successfully interrupting residual AF.
Implications:
- Cryosurgical ablation is a viable and effective treatment for drug-resistant ectopic atrial tachycardia and atrial flutter (AF).
- The technique allows for modification and preservation of atrioventricular (AV) conduction, minimizing risks of heart block.
- This approach provides a minimally invasive option for complex arrhythmias unresponsive to medical therapy.
Abstract:
Three cases with ectopic atrial tachycardia and two cases with atrial flutter (AF), unresponsive to drugs, are described clinically and electrophysiologically. The three patients of ectopic atrial tachycardia were treated by surgical removal of ectopic focus and cryocoagulation of the adjacent area, not using cardiopulmonary bypass. All of them have been in sinus rhythm and had shown no tachycardia since the operation. In one patient of AF, cryosurgical ablation around the atrioventricular (AV) node and His bundle has prevented AF without AV block. Another patient of AF underwent cryoablation around the orifice of the coronary sinus, which was the earliest activation area during AF in endocardial mapping. In this patient, AF reappeared, so cryoablation around the AV node and His bundle was performed. His heart rate decreased to 120 beat/min from 270 beats/min during AF and a radiofrequency pacemaker (Atricon) was implanted to interrupt the remaining AF. This cryosurgical procedure is successful to modify and preserve AV conduction.