The Electrophysiologic Studies on Wolff-Parkinson-White (WPW) Syndrome : With Special Reference to His Bundle Pacing on WPW Syndrome

For a long time many theories have been postulated with regard to the cause of WPW syndrome, more than 60, according to Scherf and Cohen. But the accessory bundle theory is mostly accepted as the outcome of anatomically proved accessory conduction pathway, the result of epicardial mapping for type B WPW syndrome and the therapeutic results obtained by the interruption of accessory conduction pathway. The author has attempted to examine functional property of the accessory conduction pathway of WP syndrome using the His bundle electrogram, atrial pacing and the His bundle pacing. Functional evaluation on the accessory conduction pathway is not only important for clarifying the mechanism of WPW syndrome, but also it is particularly important when surgical interruption of the accessory conduction pathway is attempted. Up to the present there has been no repot of successful His bundle pacing in many cases of WPW syndrome, so in this paper the author will mainly report the findings obtained by the His bundle pacing on WPW syndrome. Materials and Methods: Twenty patients were studied. All patients had the typical WPW pattern, i.e., a shortened PQ interval, delta wave and a widened QRS complex. It involves 10 cases of type A and 10 cases of type B. the technics of His bundle electrogram recording introduced by Scherlag and co-workers were used. A bipolar electrode catheter (distance between electrodes is 10mm) was introduced through the right femoral vein under local anesthesia and was positioned fluoroscopically close to the septal leaflet of the tricuspid valve. Another bipolar electrode catheter was introduced through the same vein and was positioned above the right atrium, and it was used for atrial pacing the recording of high right atriogram.