Surgery for the Wolff-Parkinson-White syndrome in 73 consecutive patients: what have we learnt from intraoperative mapping?

Intraoperative epicardial mapping data obtained in 73 consecutive patients operated upon for the Wolff-Parkinson-White syndrome were reviewed. Fifty-six patients had single and 17 patients had multiple accessory pathways. Except for right free wall pathways, all bypass tracts were divided using an endocardial approach. There were 2 operative deaths, 1 of which occurred after a concomitant mitral valve replacement. A total of 78 of the 87 pathways present in the 71 survivors were successfully ablated (90%). All failures occurred in patients with left posterior septal pathways. Epicardial mapping performed prior to bypass was found helpful in identifying multiple distinct accessory pathways which had been missed preoperatively. This occurred in 6 patients and led to appropriate combinations of classic operative approaches which resulted in all of these pathways being successfully divided. Further, by demonstrating that Kent bundles often presented as multiple closely-spaced or arborized accessory pathways, intraoperative mapping led to widening of the margins of surgical dissection, and in particular to an additional left atriotomy in all cases of left posterior septal accessory pathways which resulted in a substantial improvement in our rate of success.