[Total or partial electrical interruption of the atrioventricular pathway. Evaluation of clinical results and...

After checking on the efficacy and innocuity of catheter ablation of the His bundle in an experimental study in the sheep, 22 patients with supraventricular tachycardia resistant to an average of 5.5 +/- 1.7 antiarrhythmic drugs per patient underwent this procedure. The most common arrhythmias were atrial fibrillation or flutter (poorly tolerated in 14 cases), and reciprocating tachycardia (8 cases, including 3 with accessory atrioventricular pathways). In 3 of the 5 patients with intranodal tachycardia, an initial attempt was made to modify one of the two AV nodal conduction pathways. Although complete atrioventricular block was obtained in all patients, atrioventricular conduction returned in 15 patients between the 30th minute and 4th day after the procedure. A second attempt at His bundle ablation was carried out in 9 patients. During follow-up ranging from 1 to 38 months, complete or an advanced degree of atrioventricular block persisted in 5 patients, the other patients being in sinus rhythm (12 cases) or slow atrial fibrillation (2 cases). The remaining patient who was in complete atrioventricular block died of septicaemia 2 months after the procedure. The clinical results were evaluated by electrophysiological investigation, exercise testing and Holter monitoring. There were 15 satisfactory clinical results (83.3 p. 100) and 3 poor results. This series shows that interruption or modification of the normal atrioventricular conduction pathway may be performed at low risk and with good results in a high percentage of cases. It is a valuable therapeutic option in patients with supraventricular tachycardia resistant to antiarrhythmic therapy.