New observations on atrial fibrillation before and after surgical treatment in patients with the Wolff-Parkinson-White syndrome.
The records of 342 patients who received surgical treatment for the Wolff-Parkinson-White syndrome between 1968 and 1986 were reviewed to evaluate the characteristics of atrial fibrillation. The patients were classified into two groups according to the presence (n = 166) or absence (n = 176) of documented episodes of atrial fibrillation preoperatively. The mean follow-up duration was 6 years (range 2 to 20). As compared with reports based on smaller patient groups and shorter follow-up, the study revealed several new findings. 1) During follow-up, nine patients in the atrial fibrillation group developed recurrent atrial fibrillation after a successful operation; five of these nine patients did not have associated heart disease. 2) All three patients with a history of atrial fibrillation and an accessory pathway conducting in the anterograde direction only had a successful surgical procedure and no postoperative atrial fibrillation. 3) The cycle length of atrioventricular (AV) reciprocating tachycardia was significantly shorter in the atrial fibrillation group (304 +/- 42 ms, mean +/- SD) than in the no-atrial fibrillation group (321 +/- 54 ms, p less than 0.005), and the cycle length of AV reciprocating tachycardia that degenerated into atrial fibrillation (289 +/- 26 ms) was shorter than that for the AV reciprocating tachycardia without subsequent atrial fibrillation (316 +/- 51 ms, p less than 0.005). 4) Sustained atrial fibrillation was induced in 30% of patients without a history of atrial fibrillation. 5) Atrial fibrillation occurred in four patients with an accessory pathway that conducted only in the retrograde direction.(ABSTRACT TRUNCATED AT 250 WORDS)
Chen
P S
PS
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Pressley
J C
JC
Tang
A S
AS
Packer
D L
DL
Gallagher
J J
JJ
Prystowsky
E N
EN
D000293:Adolescent; D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D001283:Atrioventricular Node / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D011183:Postoperative Complications; D012008:Recurrence; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000150:complications / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000503:physiopathology; D013997:Time Factors; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000503:physiopathology / Q000601:surgery*