Selective denervation of the S-A node in the treatment of progressive central vagal bradycardia.

The condition of central hypervagism and central vagal bradycardia, up to now, have been largely overlooked. Selective surgical vagal denervation of the SA node for progressive central and local episodic reflex arc bradycardia, via right thoracotomy, is a well-tolerated procedure even in the debilitated child. The bradycardia must, of course, be atropine-responsive. It appears to be a valuable alternative to pacemakers, especially because of the necessity of using the sequential type in this form of heart block. Our follow-ups are from 8 months to 13 years in seven children (five central and two peripheral). Up to now, in an admittedly small series, there has been only one recurrence of bradycardia. This was from crossover left vagal innervation of the SA node. The incidence of this is 10% to 15%. It responded to right cervical vagotomy, following a preliminary diagnostic novocain block. We hope that these findings may lead to more awareness and investigations of conditions due to autonomic dysfunction--both central and peripheral--which may help among other conditions in the elucidation and prevention of sudden infant death syndrome (SIDS) and other related problems, and that this surgical approach will be a definitive means for the control of refractory, persistent, or recurrent vagal bradycardia.