SURGICAL CURE OF THE WOLFF-PARKINSON-WHITE-SYNDROME - A COMPARISON OF2 TECHNIQUES

Curative arrhythmia surgery for patients with symptomatic Wolff-Parkin son-White syndrome (WPW) was first performed in South Africa in Novemb er 1987. Pre-operatively all patients were symptomatic despite medical therapy, and 32% were assessed as being at risk for sudden death. The first 9 patients (November 1987 to December 1989) underwent either ep icardial or localised endocardial surgical dissections, and a cure was obtained in 66%. Aberrant atrioventricular conduction recurred in 2 p atients, 3 degrees atrioventricular heart block occurred in 2 patients , and there was 1 postoperative death in a patient who had undergone s imultaneous coronary artery bypass grafting. In contrast, a standardis ed endocardial technique was used in the subsequent 10 patients. Surgi cal cure was obtained in all 10 patients (P < 0,01). However, 1 patien t required reoperation 24 hours after the first procedure because of e arly postoperative recurrence due to initial incorrect pathway localis ation. This was successful. There were no deaths, and no patient devel oped atrioventricular heart block. In view of the excellent surgical r esults, arrhythmia surgery should be considered in select WPW patients who either have refractory symptoms or are at risk for sudden death. Furthermore, this reliable surgical technique provides an essential ba ck-up should alternative interventional procedures such as percutaneou s radiofrequency ablation fail.