Successful Surgical Interruption of the Bundle of Kent in a Patient with Wolff-Parkinson-White Syndrome

TLDR

Recurrent supraventricular tachycardia is a common complication of Wolff‑Parkinson‑White syndrome and can dominate the rhythm, leading to congestive heart failure. Isopotential body‑surface and epicardial mapping identified anomalous ventricular activation at the lateral right atrioventricular groove, guiding surgical transection of the atrioventricular junction to eliminate the WPW pathway. Five months post‑surgery the patient had no recurrence of WPW ECG changes or tachycardia, with resolution of congestive heart failure symptoms and return to work.

Abstract

Recurrent supraventricular tachycardia is a frequent complication in patients with the Wolff-Parkinson-White (WPW) syndrome. Our patient was unusual in that the arrhythmia was the predominant rhythm, and it was felt that the sustained tachycardia was responsible for signs and symptoms of congestive heart failure. The arrhythmia could not be controlled adequately with digitalis, quinidine, diphenylhydantoin, or propranolol. Atrial or ventricular pacing also failed to prevent recurrent episodes of tachycardia. Physiological and pharmacological studies suggested that an anomalous pathway was responsible for the WPW abnormality and participated in a re-entrant circuit which sustained the episodes of tachycardia. Isopotential body surface mapping suggested anomalous ventricular excitation at the lateral aspect of the right atrioventricular groove. Epicardial mapping at the time of surgery was used to localize the earliest area of anomalous ventricular activation, and surgical transection of the atrioventricular junction at that point abolished the electrocardiographic features of WPW and the recurrent tachycardia. Five months after surgery neither the ECG features of WPW nor the tachycardia has recurred. The signs and symptoms of congestive heart failure have subsided, and the patient has returned to work.