The surgical treatment of supraventricular tachyarrhythmias has undergone considerable evolution since its inception in 1968 with the treatment of a patient with Wolff-Parkinson-White (WPW) syndrome. At the present time, WPW syndrome, AV node re-entry, and ectopic atrial foci that can be localized are all amenable to surgical therapy. The surgical treatment of WPW syndrome has advanced to the extent that the surgery may be offered to a larger group of patients in order to avoid life-long medical therapy. More sophisticated mapping techniques have been developed in the animal laboratory and will soon be introduced to the operating room to allow more precise localization of arrhythmias that previously could be treated only by disruption of normal atrioventricular conduction. The use of computers to assist in epicardial, intramural, and endocardial mapping will be essential, and their introduction into the operating room should overcome the difficulties that currently limit the characterization of arrhythmias localized to the atria. Several new procedures have been developed in the animal laboratory that allow isolation of various portions of the atria without disruption of atrioventricular conduction, in anticipation that intraoperative localization will become possible. The future of electrophysiologic surgery in the treatment of supraventricular tachyarrhythmias most certainly will be marked by the elaboration of more refined techniques and the application of techniques now considered experimental to arrhythmias that are just beginning to be understood adequately.
ASJC Scopus subject areas