Localization and interruption of accessory conduction pathway in the Wolff-Parkinson-White syndrome

We operated upon 36 patients with Wolff-Parkinson-White (WPW) syndrome between 1969 and July, 1979. The relationship between the electrocardiogram (ECG), particularly the delta wave, and localization of the accessory conduction pathway (ACP) was analyzed, and the value of preoperative examinations such as vectorcardiography, echocardiography, body surface mapping, intracavitary potential study, and cardiac pacing were demonstrated. Epicardial mapping was indispensable as an intraoperative study and represented the most effective method for localizing the ACP. In some cases, endocarial potential study was found to be efficacious. Detachment of the atrium from the ventricle by an incision along the anulus at the area of earliest pre-excitation, resulted in complete correction in 26 of 28 patients operated upon between 1973 and July, 1979. In five patients multiple ACPs was corrected, although four of them required a second operation. The surgical indications in the WPW syndrome should be expanded in view of the high success rate and the safety of the operation.