Surgical cure of the Wolff-Parkinson-White syndrome--a comparison of two techniques.

Curative arrhythmia surgery for patients with symptomatic Wolff-Parkinson-White syndrome (WPW) was first performed in South Africa in November 1987. Pre-operatively all patients were symptomatic despite medical therapy, and 32% were assessed as being at risk for sudden death. The first 9 patients (November 1987 to December 1989) underwent either epicardial or localised endocardial surgical dissections, and a cure was obtained in 66%. Aberrant atrioventricular conduction recurred in 2 patients, 3 degrees atrioventricular heart block occurred in 2 patients, and there was 1 postoperative death in a patient who had undergone simultaneous coronary artery bypass grafting. In contrast, a standardised endocardial technique was used in the subsequent 10 patients. Surgical cure was obtained in all 10 patients (P < 0.01). However, 1 patient required reoperation 24 hours after the first procedure because of early postoperative recurrence due to initial incorrect pathway localisation. This was successful. There were no deaths, and no patient developed atrioventricular heart block. In view of the excellent surgical results, arrhythmia surgery should be considered in select WPW patients who either have refractory symptoms or are at risk for sudden death. Furthermore, this reliable surgical technique provides an essential back-up should alternative interventional procedures such as percutaneous radiofrequency ablation fail.

Temporary transvenous atrial pacing for the control of supraventricular tachycardia in the coronary care unit.

Until the present, temporary atrial pacing techniques for acutely ill patients with supraventricular arrhythmias have been most widely used following open heart surgery. The recent availability of stable J-shaped temporary atrial pacing catheters promises to broaden the use of atrial pacing to patients with such arrhythmias who have not had a thoracotomy. Two cases with resistant supraventricular arrhythmias were successfully treated using temporary transvenous pacing leads placed in the right atrial appendage.

Of pacemakers and statistics: the actuarial method extended.

Pacemakers cease functioning because of either natural battery exhaustion (nbe) or component failure (cf). A study of four series of pacemakers shows that a simple extension of the actuarial method, so as to incorporate Normal statistics, makes possible a quantitative differentiation between the two modes of failure. This involves the separation of the overall failure probability density function PDF(t) into constituent parts pdfnbe(t) and pdfcf(t). The approach should allow a meaningful comparison of the characteristics of different pacemaker types.

Prolonged circulatory support with the intra-aortic balloon pump after myocardial infarction.

Circulation was supported by intra-aortic balloon counterpulsation for 30 and 38 days respectively in two patients with cardiogenic shock after acute myocardial infarction. One was flown 1400 km to Cape Town for heart transplantation but died after being weaned from the pump while awaiting a suitable donor. The other underwent successful surgical closure of a ruptured ventricular septum on the 30th day, allowing time for the edges of the ventricular septal defect to fibrose. Neither significant damage to circulating blood elements nor infection occurred, confirming the feasibility of prolonged circulatory support.