Cryosurgical ablation of left parietal wall accessory atrioventricular connections through the coronary sinus without the use of extracorporeal circulation

Abstract

A simplified technique for surgical treatment of preexcitation syndrome caused by left-sided accessory atrioventricular connections without the use of extracorporeal circulation has been elaborated experimentally and used in 21 patients with tachycardia refractory to medical treatment. Cryoablation of the accessory bundles was performed by means of local cryothermia using a specially designed cryoinstrument introduced into the coronary sinus through the right atrial wall. The operations were performed after thoracotomy on the working closed heart. The signs of preexcitation and paroxysms of tachycardia disappeared in 19 of 21 patients. Coronary sinus ligation was necessary in two patients. In the rest of the patients the patency of the sinus was preserved and there were no surgical complications. This original cryosurgical technique offers a number of advantages in selected patients with Wolff-Parkinson-White syndrome.