[Percutaneous electric interruption of normal auriculoventricular conduction. Analysis of French cases]

Abstract

Since 1982, 85 patients (aged 18 to 81 years) with supraventricular arrhythmias resistant to an average of 3.8 +/- 1.2 classes of antiarrhythmic drugs, 53 of whom had underlying cardiac disease (62.3%), underwent attempted catheter ablation of the normal AV conduction pathway in 8 different French centers. The indication was atrial fibrillation and flutter in 51 cases (60%) and intranodal reentry in 16 cases (18.8%). An average of 2.5 +/- 2.3 electrical shocks of 130 to 400 joules delivered in 1 to 3 sessions successfully induced high degree AV block in 79 patients, present at the time of discharge from hospital in 43 patients (50.5%). There were 3 cases immediately complicated by non-sustained ventricular tachycardia. Late complications (1 day to 1 month) included ventricular tachycardia (2 patients) septicaemia (3 patients) and pericarditis (1 patient). Sixty nine patients were followed up for an average of 12.9 +/- 10.0 months. There was one death from septicaemia due to infection of the pacemaker and two deaths at 5 and 6 months due to cardiac failure which had been present before the procedure. Fifty six patients were asymptomatic (81.1%), 27 with high degree AV block and 29 patients with (N = 19) or without (N = 10) antiarrhythmic therapy. There were 10 failures. This study shows that closed chest interruption of the normal AV conduction pathway is an effective and relatively safe alternative method of treating supraventricular tachycardias resistant to antiarrhythmic therapy.