The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 1988
Right atrial isolation: a new surgical treatment for supraventricular tachycardia. II. Hemodynamic effects.
Surgical isolation of the body of the right atrium presents a unique hemodynamic situation in which the synchronous right atrial contraction (kick) is lost but the synchronous left atrial contraction is preserved. The hemodynamic effects of this procedure were evaluated by pacing at selected atrial sites postoperatively to simulate (1) sinus rhythm with a synchronous right atrial kick, (2) sinus rhythm without a synchronous right atrial kick, (3) right atrial tachycardia propagated to the entire heart (propagated right atrial tachycardia), and (4) right atrial tachycardia confined to the isolated right atrium with sinus rhythm in the rest of the heart (confined right atrial tachycardia). ⋯ Moreover, cardiac hemodynamic performance remained within normal limits for up to 14 weeks. Thus the right atrial isolation procedure does not adversely affect cardiac hemodynamics despite the loss of synchronous right atrial contraction during sinus rhythm, and the procedure prevents hemodynamic deterioration during right atrial tachycardia.
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J. Thorac. Cardiovasc. Surg. · Apr 1988
Right atrial isolation: a new surgical treatment for supraventricular tachycardia. I. Surgical technique and electrophysiologic effects.
This study describes the surgical technique and electrophysiologic effects of isolating the right atrium while preserving normal function and continuity of the sinoatrial node with the remainder of the heart. Thirteen adult mongrel dogs underwent normothermic cardiopulmonary bypass. A posterorlateral right atriotomy was performed that encircled the upper right atrium but excluded the atrial pacemaker complex. ⋯ Moreover, the simulated tachycardia did not affect normal sinus rhythm or normal atrioventricular conduction. It is concluded that isolation of the right atrium with preservation of normal sinoatrial node function and continuity is feasible. This technique offers an alternative to the current surgical approaches for management of refractory supraventricular tachycardias that arise in the right atrium.