The Annals of Thoracic Surgery, Vol 57, 1084-1088, Copyright © 1994 by The Society of Thoracic Surgeons
Operation for the Wolff-Parkinson-White syndrome in the catheter ablation era
GM Guiraudon, CM Guiraudon, GJ Klein, R Yee and RK Thakur
Department of Surgery, University of Western Ontario, University Hospital, London, Canada.
Catheter ablation has greatly altered surgical referral patterns for the
Wolff-Parkinson-White syndrome. We describe 51 patients (aged 9 to 63
years; 35 male, 16 female) referred for operation from our institution and
elsewhere between August 1990 and August 1993, coincident with the
inception of our ablation program. During the same period, 375 patients
with problematic Wolff-Parkinson-White syndrome had ablation procedures.
Operation was the initial therapy in 26 patients, due to physician
preference in 23 and the need for a concomitant cardiac operation in 3.
Operation was related to ablation failure in 22 patients and was urgent in
3 patients. Previous ablation was not associated with added surgical
difficulties, and all pathways were ablated intraoperatively on the first
attempt using the epicardial approach. Visible epicardial lesions were
observed in 8 patients at the site of the accessory pathway. In 2 patients,
the lesions were remote to the atrioventricular ring. There was a striking
significant increase in proportion of right free wall pathways after
attempted ablation (27% versus 8%) as compared with the preablation era. We
conclude that previous attempted ablation does not impair efficacy and
safety of operative therapy. Operation remains a useful alternative for
ablation failure and as a back-up for acute complications.
