The Annals of Thoracic Surgery, Vol 36, 345-352, Copyright © 1983 by The Society of Thoracic Surgeons
His bundle interruption for reentry tachycardia in Wolff-Parkinson- White syndrome
WC Sealy
This report relates the experience with 16 patients with Wolff-
Parkinson-White syndrome in whom His bundle interruption was performed for
reentry atrioventricular (AV) tachycardia caused by a circuit composed of
the His and Kent bundles. A review of the surgical anatomy of the area
encompassing the AV node and the His bundle is included. The reasons for
selection of His bundle interruption in the 16 patients were as follows:
(1) it is safer in the poor-risk patient; (2) the His bundle was adjacent
to the Kent bundle and could not be avoided; or (3) the His bundle was
divided after attempted interruption of the Kent bundle failed. The methods
used for interruption, either alone or in combination, included suture
ligation, electrocautery, incision, and cryothermia. This study showed that
in order to interrupt the His bundle with minimum physiological impairment,
ablation should be done at the AV node--His bundle junction. This can be
achieved in most patients with carefully applied cryothermia. If
cryothermic ablation fails, then an incision must be made that separates
the inferior aspect of the atrial septum from the right fibrous trigone.
His bundle interruption at the AV node--His bundle junction was
accomplished in 13 of the 16 patients.
