RESUMEN
A new operation to eliminate accessory pathways--epicardial electrical ablation--is described. In a group of 201 patients without concomitant disease, the mortality rate was 0.5% and the overall efficacy of the operation for free wall accessory pathways, 98%. A retrospective clinical study of 44 unselected patients was performed to examine how safe epicardial electrical ablation is. The criteria for intraoperative effectiveness were disappearance of both the delta wave and retrograde conduction and inability to induce tachycardia. In the postoperative and follow-up periods, the following were reviewed: electrocardiograms; Holter monitor recordings (24 to 26 hours); release of the myocardial-specific isoenzyme of creatine kinase; intracardiac hemodynamics and myocardial contractility (radionuclide methods); selective coronary arteriograms and ventriculograms; mean work capacity (bicycle ergometer); diagnostic transesophageal electrical stimulation; and histology of the area of ablation. The main conclusion of this study is that epicardial electrical ablation is a highly efficient and safe operation for surgical elimination of parietal accessory pathways in patients with Wolff-Parkinson-White syndrome. Its advantages are its technical simplicity and the opportunity to review results immediately during the operation.
Asunto(s)
Electrocoagulación/métodos , Sistema de Conducción Cardíaco/cirugía , Síndrome de Wolff-Parkinson-White/cirugía , Adolescente , Adulto , Anciano , Niño , Angiografía Coronaria , Creatina Quinasa/metabolismo , Electrocardiografía , Electrocardiografía Ambulatoria , Electrocoagulación/efectos adversos , Estudios de Evaluación como Asunto , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Sistema de Conducción Cardíaco/fisiología , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Miocardio/patología , Necrosis , Nitroglicerina , Ventriculografía con Radionúclidos , Estudios Retrospectivos , Síndrome de Wolff-Parkinson-White/fisiopatologíaRESUMEN
The authors assessed the outcomes of an epicardial electrical pulse destructive operation on Kent's bundle in 170 patients with the Wolff-Parkinson-White syndrome. The operation consisted in generating an electrical stimuli train of a power of 50-250 J along the fatty tenial margin of the atrioventricular sulcus, which damaged or isolated Kent's bundle. By refining the indications for application of the method, the authors succeeded in achieving 98% efficacy in abolishing the Kent bundle conduction in the absence of deaths in the latter group of patients. The technique was found to be indicated in lateral bundle localizations, except right anterolateral localizations when atrioventricular conduction disturbances may be present. Myocardial changes occurring after destruction caused no hemodynamic abnormalities and were not associated with coronary artery lesions. Increasing the force of intact myocardial contraction fully compensated a slight segmental ejection fraction deficiency at the site of destruction.
Asunto(s)
Electrocirugia/métodos , Sistema de Conducción Cardíaco/cirugía , Síndrome de Wolff-Parkinson-White/cirugía , Adulto , Anciano , Niño , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Pericardio/cirugía , Factores de TiempoRESUMEN
The article deals with a new method of treatment of the Wolff-Parkinson-White syndrome. The operation for epicardial destruction of Kent's bundle by pulsating current was developed by the authors. It is distinguished by its simplicity and the possibility to determine the efficacy of the procedures during the operation itself. The results of examination of 44 patients in the early postoperative period and in late-term periods after this operation are discussed. It was found that the electric factor does not cause structural changes of the underlying structures and does not affect the pumping function of the myocardium. The revealed changes were recorded by means of angiocardiography, coronarography, radionuclide ventriculography, and the enzyme spectrum.