Bouboulis Nick, Dougenis Dimitris, Campbell R W F, Hilton Colin J
Department of Surgery, Division of Cardiothoracic Surgery, University Medical School, Patras 26500, Greece.
World J Surg. 2002 Jan;26(1):122-8. doi: 10.1007/s00268-001-0191-4. Epub 2001 Nov 26.
There are currently two different surgical approaches to the abnormal pathway, Wolff-Parkinson-White (WPW) syndrome-the endocardial (ENDO) and epicardial (EPI) techniques. In recent years, ablation of accessory pathways can be achieved by catheter-induced radiofrequency (RF) current. This study was undertaken to assess our results of surgical treatment for WPW syndrome in the current era of catheter ablation. From 1985 to 1993, 51 patients (33 male and 18 female) with WPW syndrome underwent operations for ablation of accessory pathways. Associated anomalies included Ebstein's anomaly, coronary artery disease, and tricuspid atresia. Preoperatively, 6 patients underwent unsuccessful RF catheter ablation. Fifteen (29%) patients were operated with the ENDO technique and 36 (71%) with the EPI technique. There was no early death in either group. In the immediate postoperative period 40 (78%) patients were in sinus rhythm. The electrophysiological studies revealed successful ablation of the pathway in 50 (98%) patients. On complete late follow-up (mean, 36 months) all patients were back to preoperative levels of activity. Our experience indicates that excellent results can be achieved with each of these two techniques. The left free wall accessory pathways may be ablated in a more reproducible way with the ENDO approach. The concept that surgical ablation of accessory pathways may prevent further atrial fibrillation is supported by the low incidence in this series. Operations for WPW syndrome may become indicated for RF ablation failure, when additional procedures are required. In these cases the surgical skill should be available, and this is a skill that should not be lost.
目前，针对异常传导通路——预激综合征（WPW）有两种不同的手术方法，即心内膜（ENDO）和心外膜（EPI）技术。近年来，可通过导管诱导的射频（RF）电流实现旁路消融。本研究旨在评估在当前导管消融时代我们对WPW综合征的手术治疗结果。1985年至1993年，51例（男33例，女18例）WPW综合征患者接受了旁路消融手术。相关异常包括埃布斯坦畸形、冠状动脉疾病和三尖瓣闭锁。术前，6例患者射频导管消融未成功。15例（29%）患者采用ENDO技术手术，36例（71%）采用EPI技术手术。两组均无早期死亡病例。术后即刻，40例（78%）患者恢复窦性心律。电生理研究显示50例（98%）患者的传导通路消融成功。在完整的长期随访（平均36个月）中，所有患者的活动水平恢复到术前状态。我们的经验表明，这两种技术均可取得优异的效果。采用ENDO方法可以更可重复地消融左游离壁旁路。本系列中较低的发生率支持了手术消融旁路可预防进一步房颤的观点。当需要额外的手术时，对于射频消融失败的患者可能需要进行WPW综合征手术。在这些情况下，应具备手术技能，且这一技能不应失传。
