Control of recurrent tachycardia of Wolff-Parkinson-White syndrome by surgical ligature of the A-V bundle.

In a patient with WPW, type A, pharmacological therapy and radioactive iodine failed to control the disabling, life-threatening arrhythmia. Surgical ligation of the A-V bundle was undertaken in view of the rapidly deteriorating clinical course. Failure to identify A-V block after several sutures were placed in the A-V junction and subsequent activation of the ventricles in a heart with known A-V block demonstrates that the accessory A-V bundles may completely activate the ventricles. Complete elimination of the recurrent tachycardias after A-V ligation suggests that the normal A-V transmission system may be a crucial link in the circus pathway of WPW tachycardia.