Catheter technique for closed-chest ablation of the atrioventricular conduction system

• Published in: The New England journal of medicine Vol. 306; no. 4; pp. 194 - 200
• Main Authors: Gallagher, J J, Svenson, R H, Kasell, J H, German, L D, Bardy, G H, Broughton, A, Critelli, G
• Format: Journal Article
• Language: English
• Published: United States 28.01.1982
• Subjects: Adult; Bundle of His - physiopathology; Cardiac Catheterization - methods; Cardiac Pacing, Artificial; Electric Countershock - instrumentation; Electric Countershock - methods; Electrocardiography; Female; Follow-Up Studies; Heart Conduction System - physiopathology; Humans; Male; Middle Aged; Recurrence; Tachycardia - physiopathology; Tachycardia - therapy
• ISSN: 0028-4793

This report describes a catheter technique for ablating the His bundle and its application in nine patients with recurrent supraventricular tachycardia that was unresponsive to medical management. A tripolar electrode catheter was positioned in the region of the His bundle, and the electrode recording a large unipolar His-bundle potential was identified. In the first patient, two shocks of 25 and 50 J, respectively, were delivered by a standard cardioversion unit to the catheter electrode, resulting in an intra-His-bundle conduction defect. Subsequent delivery of 300 J resulted in complete heart block. In the next eight patients, an initial shock of 200 J was used. The His bundle was ablated by this single shock in six of these patients and by an additional shock of 300 J in one. In the remaining patient, conduction in the atrioventricular node was modified, resulting in alternating first and second-degree atrioventricular block. A stable escape rhythm was preserved in all patients. The procedure was well tolerated, without complications, and all patients have remained free of arrhythmia, without medication, for follow-up periods of two to six months.