TY - JOUR
T1 - Surgical ablation of ventricular tachycardia
T2 - Improved results with a map-directed regional approach
AU - Krafchek, J.
AU - Lawrie, G. M.
AU - Roberts, R.
AU - Magro, S. A.
AU - Wyndham, C. R.
PY - 1986
Y1 - 1986
N2 - To determine whether a regional approach to surgery for ventricular tachycardia would improve on the results of previously reported methods of endocardial resection, an analysis was performed of our surgical experience over a 5 year period. Of 46 consecutive patients operated on for recurrent sustained ventricular tachycardia or ventricular fibrillation, 39 patients with ischemic heart disease underwent subendocardial resection and/or cryoblation. The mean age of the patients was 61 ± 8 (SD) years, the mean left ventricular ejection fraction was 32 ± 11%, and the mean number of ineffective antiarrhythmic drugs was 3.8 ± 1.2 per patient. In 35 of 39 patients in whom mapping data were obtainable, 56 (86%) tachycardias had earliest sites of activation in the left ventricle and nine (14%) had earliest sites in the right ventricle. Ten patients had 14 tachycardias (21%) mapped to areas outside visible dense scar. Of these 35 patients, 10 underwent localized subendocardial resection and 25 underwent a regional procedure in which all areas activated before the surface QRS during ventricular tachycadia were excised and/or cryoblated. In the operated survivors of electrophysiologically guided surgery, three of eight (38%) patients with the localized and one of 24 (4%) patients who underwent the regional procedure had recurrence of ventricular tachycardia during a follow-up period of 1 to 59 (mean 22 ± 17) months (p = .04). The favorable outcome of regional surgery was not influenced by the presence of multiple morphologies in 54%, disparate sites of origin in 29%, or inferior wall foci in 46% of patients. These data suggest that (1) some ventricular tachycardias have earliest sites of activation outside visible dense scar and/or within the right ventricle, (2) a regional approach to arrhythmia ablation can lead to operative success in over 90% of patients, and (3) multiple morphologies, disparate sites, and inferior wall origin are not adverse prognostic factors to success when this approach is used.
AB - To determine whether a regional approach to surgery for ventricular tachycardia would improve on the results of previously reported methods of endocardial resection, an analysis was performed of our surgical experience over a 5 year period. Of 46 consecutive patients operated on for recurrent sustained ventricular tachycardia or ventricular fibrillation, 39 patients with ischemic heart disease underwent subendocardial resection and/or cryoblation. The mean age of the patients was 61 ± 8 (SD) years, the mean left ventricular ejection fraction was 32 ± 11%, and the mean number of ineffective antiarrhythmic drugs was 3.8 ± 1.2 per patient. In 35 of 39 patients in whom mapping data were obtainable, 56 (86%) tachycardias had earliest sites of activation in the left ventricle and nine (14%) had earliest sites in the right ventricle. Ten patients had 14 tachycardias (21%) mapped to areas outside visible dense scar. Of these 35 patients, 10 underwent localized subendocardial resection and 25 underwent a regional procedure in which all areas activated before the surface QRS during ventricular tachycadia were excised and/or cryoblated. In the operated survivors of electrophysiologically guided surgery, three of eight (38%) patients with the localized and one of 24 (4%) patients who underwent the regional procedure had recurrence of ventricular tachycardia during a follow-up period of 1 to 59 (mean 22 ± 17) months (p = .04). The favorable outcome of regional surgery was not influenced by the presence of multiple morphologies in 54%, disparate sites of origin in 29%, or inferior wall foci in 46% of patients. These data suggest that (1) some ventricular tachycardias have earliest sites of activation outside visible dense scar and/or within the right ventricle, (2) a regional approach to arrhythmia ablation can lead to operative success in over 90% of patients, and (3) multiple morphologies, disparate sites, and inferior wall origin are not adverse prognostic factors to success when this approach is used.
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U2 - 10.1161/01.CIR.73.6.1239
DO - 10.1161/01.CIR.73.6.1239
M3 - Article
C2 - 3698255
AN - SCOPUS:0022475836
VL - 73
SP - 1239
EP - 1247
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 6
ER -