Surgical correction of the wolff-parkinson-white syndrome in the closed heart using cryosurgery: A simplified approach

The conventional operation for ablation of accessory atrioventricular (AV) pathways in the Wolff-Parkinson-White syndrome requires an endocardial approach to the AV groove and necessitates the use of cardiopulmonary bypass and induced cardiac arrest. The feasibility of creating transmural atrial fibrosis at the level of the AV anulus in the closed heart in dogs without damaging the vascular contents of the AV fat pad was demonstrated. This was done by dissecting the fat pad from the atrium and applying a cryoprobe to the exposed atrial-anular region after retraction of the fat pad. The technique was then applied to successfully ablate 12 left parietal wall accessory pathways in 11 patients with the Wolff-Parkinson-White syndrome. This simplified approach to any parietal wall accessory pathway does not require cardiopulmonary bypass or induced cardiac arrest and may broaden the indications for this operation

Surgical treatment of Wolff-Parkinson-White syndrome: A timeless procedure?

Catheter-induced radiofrequency (RF) ablation has become the initial non-pharmacological treatment option for Wolff-Parkinson-White (WPW) syndrome. In this report, we present the successful surgical treatment of WPW syndrome in two patients in whom percutaneous ablation of the accessory pathway was not successful

Cryosurgical modification of the atrioventricular node: A closed heart approach in the dog

Intraoperative modification of the atrioventricular (AV) node to prolong refractoriness could be an alternative to His bundle ablation in patients with refractory supraventricular arrhythmias. It was postulated that a cryosurgical lesion at the posterior interatrial septum in the closed heart could achieve this. An electrophysiologic study was performed in anesthetized dogs. The AV fat pad was mobilized to expose the posteroseptal region. A cryoprobe cooled to 0 to −10°C was moved in the exposed region until reversible AV block indicated proximity of the AV node. The probe was then cooled to −70°C for 30 seconds.Four weeks later, five dogs had a favorable result with a mean prolongation of Wenckebach cycle length of 45 ± 7% (p < 0.05). Two dogs had complete heart block. Decreased (one dog) or increased (one dog) duration of freezing resulted in no change and complete heart block, respectively. Histologic examination verified partial damage to the AV node with preservation of the His bundle.Thus, 1) controlled cryoinjury to modify AV node function is feasible in the closed heart; 2) preservation of AV conduction provides an advantage over His bundle ablation