Successful Surgical Interruption of the Bundle of Kent in a Patient with Wolff-Parkinson-White Syndrome

Abstract

Recurrent supraventricular tachyeardia is a frequent complication in patients with the Wolff-Parkinson-White (WPW) syndrome. Our patient was unusual in that the arrhythmia was the predominant rhythm, and it was felt that the sustained tachyeardia was responsible for signs and symptoms of congestive heart failure. The arrhythmia could not be controlled adequately with digitalis, quinidine, diphenylhydantoin, or propranolol. Atrial or ventricular pacing also failed to prevent recurrent episodes of tachycardia.Physiological and pharmacological studies suggested that an anomalous pathway was responsible for the WPW abnormality and participated in a re-entrant circuit which sustained the episodes of tachyeardia. Isopotential body surface mapping suggested anomalous ventricular excitation at the lateral aspect of the right atrioventricular groove. Epicardial mapping at the time of surgery was used to localize the earliest area of anomalous ventricular activation, and surgical transection of the atrioventricular junction at that point abolished the electrocardiographic features of WPW and the recurrent tachyeardia. Five months after surgery neither the ECG features of WPW nor the tachycardia has recurred. The signs and symptoms of congestive heart failure have subsided, and the patient has returned to work.

Rhythms of the heart: The history of electrophysiology and its current status in South Africa

“…Nineteen sixty eight saw the first successful surgical division of an accessory AV connection responsible for reciprocating tachycardias in a patient with WPW syndrome. (31) This both proved the concept and provided a cure for the condition. Surgical removal of a left ventricular aneurysm was reported in the 1959 and was shown to prevent recurrent ventricular tachycardia.…”

Forty Years of Invasive Clinical Electrophysiology

“…Both Gallagher (cardiology) and Sealy and Cox (surgery) played major roles in advancing our understanding of the Wolff-Parkinson-White syndrome and in the development of surgical therapy. 22,23 The contributions of cardiac surgeons, including Sealy, Guiraudon, Cox and Harken, have been of great importance not only for treating cardiac arrhythmias but also in advancing the understanding of arrhythmia mechanisms. 24 Better knowledge of cardiac anatomy became a must for the invasive electrophysiologist.…”

What Have We Learned About Cardiac Arrhythmias?

“…Cardiac surgeons began to remove or isolate tissue that was the site of origin of abnormal impulse formation or dissected and interrupted critical parts of the tachycardia pathway. They made incisions in areas where multiple reentrant circuits were responsible for the arrhythmia, [21][22] such as in atrial fibrillation. 23 Close cooperation between clinical electrophysiologists, anatomists, and surgeons played a crucial role in the development of these curative interventions.…”