Deceptive surgical results in three siblings with familial Wolff-Parkinson-White syndrome

Three siblings with familial Wolff-Parkinson-White syndrome and two instances of sudden death are described. In all of them, multiple accessory pathways with a very short anterograde refractory period and rapid ventricular responses during atrial fibrillation had been documented, thus surgical ablation of the bypass tracts had been performed. Although abolition of the accessory pathway conduction had been demonstrated post-operatively, an electrophysiologic evaluation performed after 2-8 years showed resumption of conduction over the anomalous connections, with life-threatening arrhythmias during induced fast atrial rhythms. This report demonstrates that apparent success of surgery for pre-excitation syndrome, judged during the postoperative course, may be illusory in some patients, and return of accessory pathway conduction can occur later on.