Surgical correction of the Wolff-Parkinson-White syndrome in the closed heart using cryosurgery: a simplified approach.

The conventional operation for ablation of accessory atrioventricular (AV) pathways in the Wolff-Parkinson-White syndrome requires an endocardial approach to the AV groove and necessitates the use of cardiopulmonary bypass and induced cardiac arrest. The feasibility of creating transmural atrial fibrosis at the level of the AV anulus in the closed heart in dogs without damaging the vascular contents of the AV fat pad was demonstrated. This was done by dissecting the fat pad from the atrium and applying a cryoprobe to the exposed atrial-anular region after retraction of the fat pad. The technique was then applied to successfully ablate 12 left parietal wall accessory pathways in 11 patients with the Wolff-Parkinson-White syndrome. This simplified approach to any parietal wall accessory pathway does not require cardiopulmonary bypass or induced cardiac arrest and may broaden the indications for this operation.