The history of the wolff-Parkinson-white syndrome.

Melvin M Scheinman

doi:10.5041/rmmj.10083

Abstract

While Drs Wolff, Parkinson, and White fully described the syndrome in 1930, prior case reports had described the essentials. Over the ensuing century this syndrome has captivated the interest of anatomists, clinical cardiologists, and cardiac surgeons. Stanley Kent described lateral muscular connections over the atrioventricular (AV) groove which he felt were the normal AV connections. The normal AV connections were, however, clearly described by His and Tawara. True right-sided AV connections were initially described by Wood et al., while Öhnell first described left free wall pathways. David Scherf is thought to be the first to describe our current understanding of the pathogenesis of the WPW syndrome in terms of a re-entrant circuit involving both the AV node–His axis as well as the accessory pathway. This hypothesis was not universally accepted, and many theories were applied to explain the clinical findings. The basics of our understanding were established by the brilliant work of Pick, Langendorf, and Katz who by using careful deductive analysis of ECGs were able to define the basic pathophysiological processes. Subsequently, Wellens and Durrer applied invasive electrical stimulation to the heart in order to confirm the pathophysiological processes.Sealy and his colleagues at Duke University Medical Center were the first to successfully surgically divide an accessory pathway and ushered in the modern era of therapy for these patients. Morady and Scheinman were the first to successfully ablate an accessory pathway (posteroseptal) using high-energy direct-current shocks. Subsequently Jackman, Kuck, Morady, and a number of groups proved the remarkable safety and efficiency of catheter ablation for pathways in all locations using radiofrequency energy. More recently, Gollob et al. first described the gene responsible for a familial form of WPW. The current ability to cure patients with WPW is due to the splendid contributions of individuals from diverse disciplines throughout the world.

Highlights

ANATOMIC STUDIESThe story properly begins with the elucidation of the specialized conduction system of the heart
While Drs Wolff, Parkinson, and White fully described the syndrome in 1930, prior case reports had described the essentials
Their article was published in the American Heart Journal in August 1930.1 They described 11 patients with short P-R and bundle branch block, who suffered with paroxysmal supraventricular tachycardia (SVT) and/or atrial fibrillation (AF)

Summary

ANATOMIC STUDIES

The story properly begins with the elucidation of the specialized conduction system of the heart. Their article was published in the American Heart Journal in August 1930.1 They described 11 patients with short P-R and bundle branch block, who suffered with paroxysmal supraventricular tachycardia (SVT) and/or atrial fibrillation (AF) None of these patients had any evidence of structural cardiac disease, and the investigators confirmed ( had reported previously) that administration of atropine would serve to normalize AV conduction with disappearance of the “bundle branch block” pattern (Figure 1). Lev and Lerner[13] presented a detailed investigation of 33 fetal and neonatal hearts and found no evidence for any lateral AV communications They interpreted Kent’s finding of nodal tissue as being really atrial tissue: in neonates there is sparse collagen in the AV groove, and, depending on the angle of the sections, these may be misinterpreted as AV connections. It is surprising that the eponym “Kent” bundle is still used to describe abnormal AV connections

CLINICAL AND INVASIVE ENDOCARDIAL STUDIES

CATHETER ABLATION

SURGICAL CONTRIBUTIONS

FUTURE DIRECTIONS

CONCLUSION