Catheter technique for closed-chest ablation of the atrioventricular conduction system

N Engl J Med. 1982 Jan 28;306(4):194-200. doi: 10.1056/NEJM198201283060402.


This report describes a catheter technique for ablating the His bundle and its application in nine patients with recurrent supraventricular tachycardia that was unresponsive to medical management. A tripolar electrode catheter was positioned in the region of the His bundle, and the electrode recording a large unipolar His-bundle potential was identified. In the first patient, two shocks of 25 and 50 J, respectively, were delivered by a standard cardioversion unit to the catheter electrode, resulting in an intra-His-bundle conduction defect. Subsequent delivery of 300 J resulted in complete heart block. In the next eight patients, an initial shock of 200 J was used. The His bundle was ablated by this single shock in six of these patients and by an additional shock of 300 J in one. In the remaining patient, conduction in the atrioventricular node was modified, resulting in alternating first and second-degree atrioventricular block. A stable escape rhythm was preserved in all patients. The procedure was well tolerated, without complications, and all patients have remained free of arrhythmia, without medication, for follow-up periods of two to six months.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Bundle of His* / physiopathology*
  • Cardiac Catheterization / methods*
  • Cardiac Pacing, Artificial
  • Electric Countershock / instrumentation
  • Electric Countershock / methods*
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Heart Conduction System* / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Tachycardia / physiopathology
  • Tachycardia / therapy*