An experimental study on electrophysiological isolation of the right ventricle
Saito, H.
Nihon Kyobu Geka Gakkai 34(4): 484-495
1986
ISSN/ISBN: 0369-4739 PMID: 3734505 Document Number: 267956
Arrhythmogenic right ventricular dysplasia often has multiple origins of ventricular tachycardia in the entire pathological right ventricle. In this disease, isolation of the total right ventricular free wall (RVFW) to confine tachycardia into the right ventricle should be more effective than general surgical methods for each origin of ventricular tachycardia. This study was designed to develop a technique for electric isolation of the right ventricle from the remainder heart. The right ventricle was paced as a model of ventricular tachycardia with right ventricular origin and four procedures were tried in twenty dogs. In Group I (n = 3) with ventriculotomy of the RVFW, the RVFW could not be isolated and the left ventricle remained in pacing rhythm. In Group II (n = 7) with ventriculotomy of the RVFW and endocardial ventriculotomy of the crista supraventricularis connecting the septal band as author's method, the RVFW could be isolated and the left ventricle changed from pacing rhythm to sinus rhythm. In Group II' (n = 4) with ventriculotomy of the RVFW and cryocoagulation on the crista at -60.degree. C for 3 minutes as modified author's method, the RVFW could be isolated and the left ventricle changed to sinus rhythm with I.degree. atrioventricular block. In Group III (n = 6) with ventriculotomy of the RVFW, endocardial ventriculotomy of the crista and tricuspid annulus, and amputation of the anterior papillary muscles of the tricuspid valve (Guiraudon's method), three were successfully isolated but the other three failed with coronary arterial injuries. Author's isolation method is easier and less invasive for the coronary artery and tricuspid valve than Guiraudon's method. This new method with additional cryocoagulation may be certain, safe and applicable in patients with arrhythmogenic right ventricular dysplasia.