Surgery for the Wolff-Parkinson-White syndrome. The Groote Schuur Hospital experience.
Surgical division of accessory atrioventricular (AV) connections has been performed on 9 patients with the Wolff-Parkinson-White (WPW) syndrome at Groote Schuur Hospital. All patients had symptomatic paroxysmal tachycardia. The indication for surgery in 5 patients was poor control on antiarrhythmic drugs. Surgery was performed on a 15-year-old boy to prevent lifelong dependence on drugs, although his atrial fibrillation (ventricular rate greater than 300/min) was controllable with sotalol 1,280 mg daily. The remaining 3 patients required cardiac surgery for other indications and therefore their accessory pathways (APs) were divided concurrently. The AP was localised by pre-operative endocardial mapping and intra-operative epicardial mapping. There were 4 posteroseptal, 3 left free-wall and 2 right free-wall pathways. An endocardial approach was used to divide the pathways. All 5 free-wall APs were successfully divided without complications or recurrence. However, 1 patient with paroxysmal atrial fibrillation and severe unstable angina due to coronary artery disease died unexpectedly 10 days after 4-vessel coronary bypass grafting and division of a posteroseptal AP. Postoperative complications occurred in a further 2 patients with posteroseptal APs. One patient developed complete heart block and is now asymptomatic with a DDD pacemaker, while the other had recurrence of retrograde bypass conduction postoperatively, but is now successfully controlled on sotalol. Therefore 7 of the 8 survivors are free of recurrence of tachycardia on no anti-arrhythmic drugs after a mean follow-up of 14.3 months. New insights into the surgical technique, particularly for division of posteroseptal pathways, can be expected to improve the outlook.
Millar
R N
RN
Department of Medicine, University of Cape Town, RSA.
Milne
D A
DA
von Oppell
U O
UO
Reichart
B
B
D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D001283:Atrioventricular Node / Q000601:surgery; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013614:Tachycardia, Paroxysmal / Q000150:complications / Q000188:drug therapy; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000601:surgery*
D000889:Anti-Arrhythmia Agents