Summary
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.
Similar content being viewed by others
References
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: 685–704
Zipes DP, Rothbaum DA, DeJoseph RL (1974) Pre-excitation syndrome. Cardiovasc Clin 6 (Suppl I): T-209–243
Holzmann M, Scherf D (1932) Uber Elektrokardiogramme mit verkurzter Vorhof-Kammer-Distanz und positiven P-Zacken. Ztschr Klin Med 121: 404–423
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: 297–311
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: 454–462
Kent AFS (1893) Researches on the structure and function of the mammalian heart. J Physiology 14: 233–254
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: 1018–1029
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-456
Holmes DR, Osborn MJ, Gersh B, Maloney JD, Danielson GK (1982) The Wolff-Parkinson-White syndrome; A surgical approach. Mayo Clin Proc 57: 345–350
Cox JL (1983) Surgery for cardiac arrhythmias. Curr Prob Cardiol 8 (Suppl IV): IV-1–60
Lawrie GM, Lin HT, Wyndham CRC, DeBakey ME (1987) Surgical treatment of supraventricular arrhythmias. Ann Surg 205 (Suppl VI): VI-700–711
Ott DA, Garson A, Cooley DA, McNamara DG (1985) Definitive operation for refractory cardiac tachyarrhythmias in children. J Thorac Cardiovasc Surg 90: 681–689
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: 350–356
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: 1509–1512
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-496–500
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-400–403
Gallagher JJ, Selle JG, Svenson RH, (1988) Surgical treatment of arrhythmias. Am J Cardiol 61: A27-A44
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-875–872
Campbell RM, Dick M, Rosenthal A (1984) Cardiac arrhythmias in children. Annu Rev Med 35: 397–410
Giardina ACV, Ehlers KH, Engle MA (1972) Wolff-Parkinson-White syndrome in infants and children. Br Heart J 34: 839–846
Wolff GS, Han J, Curran J (1978) Wolff-Parkinson-White syndrome in the Neonate. Am J Cardiol 41: 559–563
Manatakas ME, McCue CM, Miller WW (1978) Natural History of Wolff-Parkinson-White syndrome discovered in infancy. Am J Cardiol 41: 1097–1103
Lundberg A (1982) Paroxysmal atrial tachycardia in infancy: Long-term follow-up study of 49 subjects. Pediatrics 70 (Suppl IV): IV-638–642
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-130–135
Dick M, Campbell RM (1984) Advances in the management of cardiac arrhythmias in children. Pediatr Clin North Am 31 (Suppl VI): VI-1175–1195
Klein GJ, Sharma AD, Yee R (1988) An approach to therapy for paroxysmal supraventricular tachycardia. Am J Cardiol 61: A77-A82
Campbell RM, Hammon JW, Echt DS, Graham TP (1987) Surgical treatment of pediatric cardiac arrhythmia. J Pediatr 110 (Suppl IV): IV-501–508
Castellanos A, Myerburg RJ (1987) Changing perspectives in the preexcitation syndromes. (editorial) N Engl J Med 317: 109–111
Princhette ELC, Prystowsky EN, Benditt DG, Gallagher JJ (1980) “Dual Atrioventricular Nodal Pathways” in Patients with Wolff-Parkinson-White Syndrome. Br Heart J 43: 7–13
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-1080–1085
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-409–416
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-1141–1152
Gillette PL, Garson A, Kugler JD (1979) Wolff-Parkinson-White syndrome in children: Electrophysiologic and pharmacologic characteristics. Circulation 60: 1487–1495
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: 353–359
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: 651–655
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: 576–579
Milstein S, Sharma AD, Klein GJ (1986) Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern. Am J Cardiol 57: 1097–1100
Klein GJ, Gulamhusein SS (1983) Intermittent preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 52: 292–296
Wellens HJ, Durrer D (1974) Wolff-Parkinson-White syndrome and atrial fibrillation. Am J Cardiol 34: 777–782
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): 53–59
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-373–381
Prystowsky EN (1988) Indications for intracardiac electrophysiologic studies in patients with supraventricular tachycardia. Circulation 75 (Suppl III): III-119–122
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dick, M., Vaporicyan, A., Bove, E.L. et al. Surgical management of children and young adults with the Wolff-Parkinson-White syndrome. Heart Vessels 4, 229–236 (1988). https://doi.org/10.1007/BF02058591
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02058591