Of 175 patients treated surgically for potentially lethal or refractory cardiac
tachyarrhythmias, 53 underwent mapping and definitive operation using cryoablative techniques as the primary or adjunctive method. Included were 16 patients with
supraventricular tachycardia caused by accessory pathways (
Kent bundle) in the right anterior or posterior paraseptal location.
Cryoablation was successful in abolishing
tachycardia in 93.7% (15 of 16). Six patients (100%) with permanent junctional
reciprocating tachycardia were cured by
cryoablation. Eighteen of 19 patients with
atrial ectopic tachycardia were treated by
cryoablation alone or in combination with excision of the atrial appendage, with success in 15 (83.3%). Five of these were left atrial foci cured by
cryoablation. Fourteen right atrial foci were treated by excision of the appendage only (1 patient), excision of the appendage and local
cryoablation (8 patients), and
cryoablation alone (5 patients). Three of these underwent partial (2 patients) or complete (1 patient) atrial disconnection after excisional and cryoablative techniques failed to control the
tachycardia. Multiple ectopic atrial foci were common (9 patients), and successful
cryoablation was accomplished in 100% of the patients with a single atrial ectopic focus (10 patients) but in only 66% of those with multiple foci. Thirteen of 19 infants with critical
ventricular tachycardia were treated by
cryoablation at the site of the ectopic focus, either alone or in combination with excision of the area. Elimination of
tachycardia was accomplished in 13 patients (100%). Myocardial
hamartoma (Purkinje cell
tumor) was the histological diagnosis in 11 of the infants with
ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)