Anatomically guided surgery to the AV node. AV nodal skeletonization: experience in 46 patients with AV nodal reentrant tachycardia

We report our combined experience with operative therapy foratrioventricular nodal tachycardia using an anatomically guided procedure.The operative rationale was to dissect the AV node with the intent ofmodifying perinodal tissues (skeletonization). The anterior septal andposterior septal regions were initially approached epicardially tofacilitate endocardial dissection. Under normothermic cardiopulmonarybypass, the right atrial septum was mobilized and the intermediate AV nodewas exposed anterior to the tendon of Todaro. Ablation of concomitantaccessory pathways was done prior to AV nodal skeletonization. Forty-sixpatients aged 9-71 years (mean 36) were operated upon. Five patients hadaccessory pathways in addition to AV nodal reentry. Atelectro-physiological study prior to discharge, no patient had an AV blockalthough anterograde and retrograde Wenckebach cycle lengths weresignificantly prolonged. Ten patients had a retrograde AV block. The 46patients were free of arrhythmia and not taking antiarrhythmic medicationafter a follow-up of 1-45 months (mean 17). Three patients had a recurrenceof the tachycardia 10 days, 2 months and 7 months post-operatively,respectively. All patients had a subsequently successful reoperation.