Heart and Vessels

, Volume 4, Issue 4, pp 229–236 | Cite as

Surgical management of children and young adults with the Wolff-Parkinson-White syndrome

  • Macdonald DickII
  • Ara Vaporicyan
  • Edward L. Bove
  • Fred Morady
  • William A. Scott
  • Burt I. Bromberg
  • Gerald A. Serwer
  • Steven F. Bolling
  • Douglas M. Behrendt
  • Amnon Rosenthal


The Wolff-Parkinson-White syndrome, as originally described, includes palpitations, tachycardia, and an abnormal electrocardiogram (short PR interval and wide QRS complex). The clinical manifestations are dependent upon a reentrant tachycardia supported by an accessory connection bridging the atrioventricular junction and frequently appear during the first two decades of life. Palpitations are the usual symptoms; less frequently, severe symptoms, such as syncope and sudden death, may result from very rapid atrioventricular conduction across the accessory connection during atrial fibrillation. We report the surgical management of 30 young patients with this syndrome, including 6 with life-threatening tachycardia. Surgical interruption of the accessory connection(s) was curative in 90% (27/30) of the patients; life-threatening symptoms were eliminated in the other three. Based on the limited knowledge of the natural history of the Wolff-Parkinson-White syndrome, the individual patient symptoms, and the electrophysiologic properties of each patient's accessory pathway(s), an algorithm is presented outlining the treatment options. This experience strongly suggests that surgical treatment of the Wolff-Parkinson-White syndrome is safe, effective, and possibly the preferred treatment for this disorder in selected young symptomatic patients.

Key words

Wolff-Parkinson-White Surgery Supraventricular tachycardia Sudden death Electrophysiology 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wolff L, Parkinson J, White PD (1930) Bundle branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia. Am Heart J 5: 685–704Google Scholar
  2. 2.
    Zipes DP, Rothbaum DA, DeJoseph RL (1974) Pre-excitation syndrome. Cardiovasc Clin 6 (Suppl I): T-209–243Google Scholar
  3. 3.
    Holzmann M, Scherf D (1932) Uber Elektrokardiogramme mit verkurzter Vorhof-Kammer-Distanz und positiven P-Zacken. Ztschr Klin Med 121: 404–423Google Scholar
  4. 4.
    Wolferth CC, Wood FC (1933) The mechanism of production of short P-R intervals and prolonged QRS complexes in patients with presumably undamaged hearts: Hypothesis of an accessory pathway of auriculoventricular conduction (bundle of Kent). Am Heart J 8: 297–311Google Scholar
  5. 5.
    Wood FC, Wolferth CC, Geckeler GD (1943) Histologic demonstration of accessory muscular connections between auricle and ventricle in a case of short P-R interval and prolonged QRS complex. Am Heart J 25: 454–462Google Scholar
  6. 6.
    Kent AFS (1893) Researches on the structure and function of the mammalian heart. J Physiology 14: 233–254Google Scholar
  7. 7.
    Cobb FR, Blumenschein SD, Sealy WC, Boineau JP, Wagner GS, Wallace AG (1968) Successful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation 38: 1018–1029PubMedGoogle Scholar
  8. 8.
    Sealy WC, Gallagher JJ, Wallace AG (1976) The surgical treatment of Wolff-Parkinson-White syndrome: Evolution of improved methods for identification of interruption of the Kent bundle. Ann Thorac Surg 22 (Suppl V): V-443–V-456Google Scholar
  9. 9.
    Holmes DR, Osborn MJ, Gersh B, Maloney JD, Danielson GK (1982) The Wolff-Parkinson-White syndrome; A surgical approach. Mayo Clin Proc 57: 345–350PubMedGoogle Scholar
  10. 10.
    Cox JL (1983) Surgery for cardiac arrhythmias. Curr Prob Cardiol 8 (Suppl IV): IV-1–60Google Scholar
  11. 11.
    Lawrie GM, Lin HT, Wyndham CRC, DeBakey ME (1987) Surgical treatment of supraventricular arrhythmias. Ann Surg 205 (Suppl VI): VI-700–711Google Scholar
  12. 12.
    Ott DA, Garson A, Cooley DA, McNamara DG (1985) Definitive operation for refractory cardiac tachyarrhythmias in children. J Thorac Cardiovasc Surg 90: 681–689PubMedGoogle Scholar
  13. 13.
    Erickson CC, Kugler JD, Cheatham JP, Latson LA, Gumbiner CH, Hofschire PJ, Fleming WH (1986) Surgical treatment of children and adolescents with Wolff-Parkinson-White syndrome. Nebr Med J 71: 350–356PubMedGoogle Scholar
  14. 14.
    Holmes DR Jr, Danielson GK, Gersh BJ, Osborn, MJ, Wood DL, McLaran C, Sugrue DD, Porter CJ, Hammill SC (1985) Surgical treatment of accessory atrioventricular pathways and symptomatic tachycardia in children and young adults. Am J Cardiol 55: 1509–1512PubMedGoogle Scholar
  15. 15.
    Dick M, Behrendt DM, Byrum CJ, Sealy WC, Stern AM, Hees P, Rosenthal A (1981) Tricuspid atresia and the Wolff-Parkinson-White syndrome: Evaluation methodology and successful surgical treatment of the combined disorders. Am Heart J 101 (Suppl IV): IV-496–500Google Scholar
  16. 16.
    Byrum CJ, Wahl RA, Behrendt DM, (1982) Ventricular fibrillation associated with use of digitalis in a newborn infant with Wolff-Parkinson-White syndrome. J Pediatr 101 (Suppl III): III-400–403Google Scholar
  17. 17.
    Gallagher JJ, Selle JG, Svenson RH, (1988) Surgical treatment of arrhythmias. Am J Cardiol 61: A27-A44Google Scholar
  18. 18.
    Garson A, Gillette PC, McNamara DG (1981) Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients. J Pediatr 98 (Suppl VI): VI-875–872Google Scholar
  19. 19.
    Campbell RM, Dick M, Rosenthal A (1984) Cardiac arrhythmias in children. Annu Rev Med 35: 397–410PubMedGoogle Scholar
  20. 20.
    Giardina ACV, Ehlers KH, Engle MA (1972) Wolff-Parkinson-White syndrome in infants and children. Br Heart J 34: 839–846PubMedGoogle Scholar
  21. 21.
    Wolff GS, Han J, Curran J (1978) Wolff-Parkinson-White syndrome in the Neonate. Am J Cardiol 41: 559–563PubMedGoogle Scholar
  22. 22.
    Manatakas ME, McCue CM, Miller WW (1978) Natural History of Wolff-Parkinson-White syndrome discovered in infancy. Am J Cardiol 41: 1097–1103PubMedGoogle Scholar
  23. 23.
    Lundberg A (1982) Paroxysmal atrial tachycardia in infancy: Long-term follow-up study of 49 subjects. Pediatrics 70 (Suppl IV): IV-638–642Google Scholar
  24. 24.
    Deal BJ, Keane JF, Gillette PC, Garson A (1985) Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: Management and follow-up. J Am Coll Cardiol 5 (Suppl I): I-130–135Google Scholar
  25. 25.
    Dick M, Campbell RM (1984) Advances in the management of cardiac arrhythmias in children. Pediatr Clin North Am 31 (Suppl VI): VI-1175–1195Google Scholar
  26. 26.
    Klein GJ, Sharma AD, Yee R (1988) An approach to therapy for paroxysmal supraventricular tachycardia. Am J Cardiol 61: A77-A82Google Scholar
  27. 27.
    Campbell RM, Hammon JW, Echt DS, Graham TP (1987) Surgical treatment of pediatric cardiac arrhythmia. J Pediatr 110 (Suppl IV): IV-501–508Google Scholar
  28. 28.
    Castellanos A, Myerburg RJ (1987) Changing perspectives in the preexcitation syndromes. (editorial) N Engl J Med 317: 109–111PubMedGoogle Scholar
  29. 29.
    Princhette ELC, Prystowsky EN, Benditt DG, Gallagher JJ (1980) “Dual Atrioventricular Nodal Pathways” in Patients with Wolff-Parkinson-White Syndrome. Br Heart J 43: 7–13PubMedGoogle Scholar
  30. 30.
    Klein GJ, Bashore TM, Sellers TD, Pritchett ELC, Smith WM, Gallagher JJ (1979) Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 301 (Suppl XX): XX-1080–1085Google Scholar
  31. 31.
    Sung RJ, Castellanos A, Mallon SM, Bloom MG, Gelband H. Myerburg RJ (1977) Mechanisms of spontaneous alternation between reciprocating tachycardia and atrial flutter-fibrillation in the Wolff-Parkinson-White syndrome. Circulation 56 (Suppl III): III-409–416Google Scholar
  32. 32.
    Waspe LE, Brodman R, Kim SG, Fisher JD (1986) Susceptibility to atrial fibrillation and ventricular tachyarrhythmia in the Wolff-Parkinson-White syndrome: Role of the accessory pathway. Am Heart J 112 (Suppl VI): VI-1141–1152Google Scholar
  33. 33.
    Gillette PL, Garson A, Kugler JD (1979) Wolff-Parkinson-White syndrome in children: Electrophysiologic and pharmacologic characteristics. Circulation 60: 1487–1495PubMedGoogle Scholar
  34. 34.
    Cosio FG, Benson DW, Anderson RW, Hession WT, Pritzker MR, Kriett JM, Benditt DG (1982) Onset of atrial fibrillation during antidromic tachycardia: Association with sudden cardiac arrest and ventricular fibrillation in a patient with Wolff-Parkinson-White syndrome. Am J Cardiol 50: 353–359PubMedGoogle Scholar
  35. 35.
    Wiedermann CJ, Becker AE, Hopferwieser T, Muhlberger V, Knapp E (1987) Sudden death in a young competitive athlete with Wolff-Parkinson-White syndrome. Heart J 8: 651–655Google Scholar
  36. 36.
    Rinne C, Klein GJ, Sharma AD, Yee R, Milstein S. Rattes MF (1987) Relation between clinical presentation and induced arrhythmias in the Wolff-Parkinson-White syndrome. Am J Cardiol 60: 576–579PubMedGoogle Scholar
  37. 37.
    Milstein S, Sharma AD, Klein GJ (1986) Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern. Am J Cardiol 57: 1097–1100PubMedGoogle Scholar
  38. 38.
    Klein GJ, Gulamhusein SS (1983) Intermittent preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 52: 292–296PubMedGoogle Scholar
  39. 39.
    Wellens HJ, Durrer D (1974) Wolff-Parkinson-White syndrome and atrial fibrillation. Am J Cardiol 34: 777–782PubMedGoogle Scholar
  40. 40.
    Wellens HJ (1983) Wolff-Parkinson-White syndrome, Part I, Diagnosis, arrhythmias, and identification of the high risk patient. Mod Concepts Cardiovasc Dis 52 (Supples XI, XII): 53–59Google Scholar
  41. 41.
    Sharma AD, Yee R, Guiraudon G, Klein GJ (1987) Sensitivity and specificity of invasive and noninvasive testing for risk of sudden death in Wolff-Parkinson-White syndrome. J Am Coll Cardiol 10 (Suppl II): II-373–381Google Scholar
  42. 42.
    Prystowsky EN (1988) Indications for intracardiac electrophysiologic studies in patients with supraventricular tachycardia. Circulation 75 (Suppl III): III-119–122Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • Macdonald DickII
    • 1
  • Ara Vaporicyan
    • 1
  • Edward L. Bove
    • 1
  • Fred Morady
    • 1
  • William A. Scott
    • 1
  • Burt I. Bromberg
    • 1
  • Gerald A. Serwer
    • 1
  • Steven F. Bolling
    • 1
  • Douglas M. Behrendt
    • 1
  • Amnon Rosenthal
    • 1
  1. 1.Division of Pediatric CardiologyC. S. Mott Children's Hospital, University of Michigan Medical CenterAnn ArborUSA

Personalised recommendations