Catheter and Surgical Treatment of Cardiac Arrhythmias

Scheinman, Melvin M.

doi:10.1001/jama.1990.03440010077035

Cited by 4 publications

(1 citation statement)

References 34 publications

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“…In some very resistant cases, in which DC or radiofrequency [12] ablative procedures are not feasible or refused by the patient, type Ic drugs including flecainide or propafe none or a type III agent amiodarone can be used. Finally surgical ablation of the extranodal (perinodal) pathway can be performed Fig.…”

Section: Treatment O F Paroxysmal Svtmentioning

confidence: 99%

Supraventricular Tachycardia: Diagnosis and Treatment

Dreifus

Hessen²

1990

Cardiology

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Specific mechanisms of supraventricular tachycardia include sinoatrial, intra-atrial, atrioventricular (AV) nodal as well as concealed and manifest bypass tract reentry. In dual pathway reentry, at least one of the pathways involves the AV node, usually the slow pathway and the other pathway, perinodal fibers within the atria. Localization of the perinodal fibers is critical for ablative procedures to eliminate AV nodal tachycardias. Other mechanisms of supraventricular tachycardia include chaotic atrial tachycardia and automatic atrial tachycardia with and without AV block. However, drug therapy includes intravenous adenosine 6 mg, as well as the older standbys of digoxin, calcium and β-blocking agents, and type la and lc antiarrhythmias. In resistance cases, amiodarone is usually effective. However, for incessant supraventricular mechanisms, catheter or surgical ablative techniques are recommended to eliminate long-term drug administration.

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Section: Treatment O F Paroxysmal Svtmentioning

confidence: 99%

Supraventricular Tachycardia: Diagnosis and Treatment

Dreifus

Hessen²

1990

Cardiology

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Argon laser ablation or modification of the atrioventricular conduction system in refractory supraventricular tachycardia

Saksena

Gielchinsky

1990

The American Journal of Cardiology

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Modification of atrioventricular node transmission properties by intraoperative neodymium-YAG laser photocoagulation in dogs

Littmann¹,

Svenson²,

Tomcsányi³

et al. 1991

Journal of the American College of Cardiology

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The purpose of this study was to test the feasibility of neodymium-yttrium-aluminum-garnet (Nd-YAG) laser photocoagulation of the atrioventricular (AV) node to control the ventricular rate during rapid atrial rhythms without creating AV block. In 12 dogs on normothermic cardiopulmonary bypass, short laser pulses were delivered to an area between the coronary sinus orifice and the site of the most proximally recorded His deflection until second degree AV block occurred at a paced atrial rate of 200 beats/min. Long-term effects on AV node function were followed up for 3 months. Three animals developed chronic high grade AV block. In nine animals with preserved 1:1 conduction, the mean (+/- SEM) critical atrial cycle length resulting in AV node Wenckebach periodicity increased from 183 +/- 6 to 261 +/- 24 ms (+43%), the mean RR interval during induced atrial fibrillation increased from 248 +/- 14 to 330 +/- 27 ms (+32%) and the shortest RR interval during atrial fibrillation increased from 215 +/- 11 to 275 +/- 20 ms (+28%). Laser effects were not reversed by isoproterenol infusion. Histologic examination of the irradiated area showed fibrotic changes in the AV node and fatty metamorphosis. This study suggests that 1) graded Nd-YAG laser photocoagulation of the AV node region in dogs results in long-term modification of anterograde AV node transmission properties; 2) 1:1 conduction during sinus rhythm usually remains preserved, but ventricular rate during rapid atrial rhythms is chronically reduced; and 3) progression to high grade AV block occurs in a minority of animals.(ABSTRACT TRUNCATED AT 250 WORDS)

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Catheter and Surgical Treatment of Cardiac Arrhythmias

Cited by 4 publications

References 34 publications

Supraventricular Tachycardia: Diagnosis and Treatment

Supraventricular Tachycardia: Diagnosis and Treatment

Argon laser ablation or modification of the atrioventricular conduction system in refractory supraventricular tachycardia

Modification of atrioventricular node transmission properties by intraoperative neodymium-YAG laser photocoagulation in dogs

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