His Bundle Interruption for Reentry Tachycardia in Wolff-Parkinson-White Syndrome

Abstract

This report relates the experience with 16 patients with Wolff-Parkinson-White syndrome in whom His bundle interruption was performed for reentry atrioventricular (AV) tachycardia caused by a circuit composed of the His and Kent bundles. A review of the surgical anatomy of the area encompassing the AV node and the His bundle is included. The reasons for selection of His bundle interruption in the 16 patients were as follows: (1) it is safer in the poor-risk patient; (2) the His bundle was adjacent to the Kent bundle and could not be avoided; or (3) the His bundle was divided after attempted interruption of the Kent bundle failed. The methods used for interruption, either alone or in combination, included suture ligation, electrocautery, incision, and cryothermia. This study showed that in order to interrupt the His bundle with minimum physiological impairment, ablation should be done at the AV node-His bundle junction. This can be achieved in most patients with carefully applied cryothermia. If cryothermic ablation fails, then an incision must be made that separates the inferior aspect of the atrial septum from the right fibrous trigone. His bundle interruption at the AV node-His bundle junction was accomplished in 13 of the 16 patients. Surgical Anatomy of the AV Node and His Bundle