Surgical treatment of the Wolff-Parkinson-White syndrome--experiences in 120 patients.

Abstract

Since January 1984, 120 patients (78 male, 42 female; aged 3 to 66 years) with the Wolff-Parkinson-White (WPW) syndrome have been operated upon. The indication for surgery was documented recurrent, paroxysmal tachycardia refractory to medical treatment in 118 cases. Twenty-two patients (18%) had additional heart disease. One hundred and twenty patients had a total of 140 accessory pathways (AP). AP were localized at the left free wall in 63% (87 AP), at the right free wall in 24% (35 AP), and septally in 13% (18 AP). Sixteen patients (13%) had multiple AP (12 patients had two and four patients had three AP), 124 AP were known pre-operatively (88%), 133 were localized intra-operatively (94%) and seven were diagnosed during re-operation (6%). Surgery in 28 patients with left lateral AP was via the epicardial approach and the endocardial approach in 59. Of 15 patients with right lateral AP, the surgical approach was epicardial in two and transmural in 13. A cryosurgery was also used in 117 patients. Fifteen patients suffered recurrences, in 12 of whom repeat surgery was required. One hundred and thirty-six AP (97%) were dissected successfully, of which 14 (10%) were ablated during re-operation. All patients survived the initial operation, but two patients died after re-operation. One patient is pacer-dependent due to persisting postoperative atrioventricular (AV) block. We conclude that surgical dissection of accessory pathways can be offered as an alternative to non-surgical treatment modes, at a low risk and with a high success rate.