Predictors of surgical mortality and long-term results of endocardial resection for drug-refractory ventricular tachycardia.
The results of surgical therapy performed in 51 consecutive patients with ventricular tachycardia were reviewed to determine short- and long-term predictors of success of such therapy in preventing recurrences of life-threatening ventricular arrhythmias. Of 41 patients (80%) who survived surgery, 40 had postoperative programmed stimulation and, of these patients, 78% (n = 31) had no inducible ventricular tachycardia on no antiarrhythmic therapy. This group had a very low incidence of arrhythmia recurrence, with only one nonfatal episode of ventricular tachycardia after a mean follow-up of 41 +/- 30 months. In contrast, two of the nine patients (22%) who had inducible arrhythmias postoperatively had cardiac arrest (p = 0.12). Multivariate analysis identified two significant predictors of perioperative mortality in our patients: increased duration of cardiopulmonary bypass time and increased baseline pulmonary capillary wedge pressure. It is concluded that (1) patients who do not have inducible ventricular tachycardia after arrhythmia surgery have a very low incidence of recurrent arrhythmia and (2) prolonged time of cardiopulmonary bypass and increased pulmonary capillary wedge pressure are predictive of perioperative mortality.
Mittleman
R S
RS
Department of Medicine, University of Massachusetts Medical Center, Worcester 01655.
Candinas
R
R
Dahlberg
S
S
Vander Salm
T
T
Moran
J M
JM
Huang
S K
SK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D004699:Endocardium / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012008:Recurrence; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery