Electrophysiologically guided surgical treatment of recurrent sustained ventricular tachycardia: variables influencing the decision to intervene

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Recurrent sustained ventricular tachycardia (VTRS) in the setting of ischemic heart disease but unrelated to an acute ischemic event is often a life-threatening complication refractory to both medical and surgical therapy.1 It is most frequently seen in two groups of patients: 1) postmyocardial infarction patients with ventricular aneurysm formation; and 2) patients without discrete aneurysm formation but with scar tissue replacement of a large portion of the left ventricle. Patients with discrete ventricular aneurysm complicated by VTRS have received more attention with respect to the surgical approach to management.

Standard ventricular aneurysmectomy with or without concomitant aortocoronary bypass grafting has been generally unsuccessful in controlling recurrent ventricular tachycardia.2–6 Intraoperative epicardial and endocardial mapping techniques have been utilized to guide more extensive surgical excision and ablation of the electrophysiologic site responsible for the VTRS.7–9 Early experience with this electrophysiologically guided surgical approach has been encouraging.10–12

Many variables may bias selection of surgical candidates and subsequent results. Three patients with postinfarction VTRS undergoing electrophysiologically guided ventricular resection are presented to illustrate some of the variables influencing patient selection as well as intraoperative electrophysiologic and surgical management.

Materials and methods

Three patients were selected from a larger group of 24 referred for electrophysiologic diagnosis and management of VTRS during a recent three-month period ending in January 1982. All patients had previous angiographically documented myocardial infarction manifested as either a large akinetic scar or dyskinetic left ventricular aneurysm. All three patients had medically refractory ventricular tachycardia either alone or associated with . . .



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