Cryosurgical ablation of accessory atrioventricular pathways without cardiopulmonary bypass: an epicardial approach for Wolff-Parkinson-White syndrome.

An epicardial approach has been developed and applied to 31 Kent bundles (23 parietal, 1 right anteroseptal, and 7 posteroseptal bundles) in 28 patients with Wolff-Parkinson-White syndrome. Our technique consists of dissection of the atrioventricular fat pad of the Kent bundle site using an ultrasonic aspirator and subsequent cryosurgical ablation. For the left parietal and posteroseptal pathways, the apex of the heart has to be retracted upward, but this maneuver was well tolerated in all patients. Moreover, even through a narrow operative field, the ultrasonic aspirator permitted deliberate dissection on the beating heart without injury to major coronary vessels or the atrial wall. In 89% of the patients, operation was performed without the use of heart-lung bypass. All patients were free from preexcitation. With this technique, all Kent bundles except that adjacent to the atrioventricular node can be ablated on the beating heart, usually without heart-lung bypass.