SURGICAL-PROCEDURE FOR THE CURE OF ATRIOVENTRICULAR JUNCTIONAL (AV NODE) REENTRANT TACHYCARDIA - ANATOMIC AND ELECTROPHYSIOLOGIC EFFECTS OFDISSECTION OF THE ANTERIOR ATRIONODAL CONNECTIONS IN CANINE MODEL
Ma. Mcguire et al., SURGICAL-PROCEDURE FOR THE CURE OF ATRIOVENTRICULAR JUNCTIONAL (AV NODE) REENTRANT TACHYCARDIA - ANATOMIC AND ELECTROPHYSIOLOGIC EFFECTS OFDISSECTION OF THE ANTERIOR ATRIONODAL CONNECTIONS IN CANINE MODEL, Journal of the American College of Cardiology, 24(3), 1994, pp. 784-794
Objectives. This study was undertaken to examine the electrophysiologi
c and anatomic effects of a surgical procedure that cures the anterior
(common) type of atrioventricular (AV) junctional reentrant tachycard
ia. Background. The procedure was designed to interrupt the reentrant
circuit at the point of earliest atrial activation during AV junctiona
l reentrant tachycardia, the anterior atrionodal connections. Methods.
Atrioventricular node function and the sequence of electrical excitat
ion of Koch's triangle were examined in 18 dogs. Excitation of Koch's
triangle was mapped using a 60-channel mapping system. Surgical dissec
tion was performed in 10 dogs and a sham procedure in 8. After 28 to 3
5 days, AV node function and the atrial excitation pattern were reasse
ssed. The AV junction was examined using light microscopy. Results. So
me degree of AV node damage was visible in all dogs in the dissection
group, but it was minor in 40% of cases. The anterior part of the AV n
ode was disconnected from the anterior atrionodal connections in all c
ases. Anterograde AV node function was mildly impaired. The median AH
interval was increased (62 vs. 76 ms [interquartile ranges 48 to 72 an
d 64 to 104, respectively], p = 0.05), and the AV Wenckebach cycle len
gth was increased (210 vs. 245 ms [interquartile ranges 200 to 230 and
210 to 260, respectively], p = 0.02). The degree of impairment of con
duction was directly proportional to the length of dissection (p < 0.0
5) but not to the degree of damage to the AV node. Ventriculoatrial (V
A) conduction was destroyed in 50% of dogs undergoing dissection but i
n none of those with a sham operation (p < 0.04). The AV node remained
responsive to autonomic blocking drugs, and atrial mapping during ven
tricular pacing revealed that the site of exit from the AV node had be
en altered. Conclusions. The atrionodal connections closest to the His
bundle are the preferred route of conduction through the AV node duri
ng normal AV or VA conduction. Destruction of these connections modifi
es AV node conduction. The surgical procedure selectively interrupts t
hese connections, and this interruption is likely to be the mechanism
of cure.