Catheter-Induced Ablation of the Atrioventricular Junction to Control Refractory Supraventricular Arrhythmias

TLDR

Recurrent supraventricular tachycardia in five patients was refractory to conventional and experimental drugs. The study aims to determine whether catheter‑guided DC shock ablation of the AV junction can replace open‑heart His‑bundle ablation. The technique delivers DC shocks via an electrode catheter positioned adjacent to the His bundle. All patients achieved complete AV block, one died six weeks after shock therapy, and the remaining patients maintained block for 4–12 months, with mild CK‑MB elevations but no tricuspid insufficiency. JAMA 1982;248:851‑855.

Abstract

Five patients with recurrent bouts of supraventricular tachycardia proved resistant or became intolerant of both conventional and experimental drugs. These patients were subjected to a new procedure involving delivery of DC shocks to an electrode catheter positioned adjacent to the His bundle. Complete atrioventricular (AV) block was produced in all, one patient died suddenly six weeks after shock therapy, and the remainder had complete AV block with follow-up intervals ranging from four to 12 months. Shock therapy was associated with mild elevations of creatine phosphokinase MB (31± 18 units), but there was no hemodynamic evidence of tricuspid insufficiency. If this new technique proves safe and effective, it should supplant the need for open heart surgical procedures for His-bundle ablation. (<i>JAMA</i>1982;248:851-855)