Surgical implications in the current treatment of Wolff-Parkinson-White syndrome

There are currently two different surgical approaches to the abnormal pathway, Wolff-Parkinson-White (WPW) syndrome-the endocardial (ENDO) and epicardial (EPI) techniques. In recent years, ablation of accessory pathways can be achieved by catheter-induced radiofrequency (RF) current. This study was undertaken to assess our results of surgical treatment for WPW syndrome in the current era of catheter ablation. From 1985 to 1993, 51 patients (33 male and 18 female) with WPW syndrome underwent operations for ablation of accessory pathways. Associated anomalies included Ebstein's anomaly, coronary artery disease, and tricuspid atresia. Preoperatively, 6 patients underwent unsuccessful RF catheter ablation. Fifteen (29%) patients were operated with the ENDO technique and 36 (71%) with the EPI technique. There was no early death in either group. In the immediate postoperative period 40 (78%) patients were in sinus rhythm. The electrophysiological studies revealed successful ablation of the pathway in 50 (98%) patients. On complete late follow-up (mean, 36 months) all patients were back to preoperative levels of activity. Our experience indicates that excellent results can be achieved with each of these two techniques. The left free wall accessory pathways may be ablated in a more reproducible way with the ENDO approach. The concept that surgical ablation of accessory pathways may prevent further atrial fibrillation is supported by the low incidence in this series. Operations for WPW syndrome may become indicated for RF ablation failure, when additional procedures are required. In these cases the surgical skill should be available, and this is a skill that should not be lost.