Surgery for control of recurrent life-threatening ventricular tachyarrhythmias within 2 months of myocardial infarction.
Twenty-seven patients (mean age 57 +/- 7 years) underwent surgery for control of recurrent drug-refractory ventricular tachyarrhythmias (uniform ventricular tachycardia alone in 9 patients, ventricular tachycardia and ventricular fibrillation in 15 and ventricular fibrillation alone in 3) within 2 months of acute myocardial infarction. The mean number of major arrhythmic episodes per patient was 15 (range 2 to 200) and of drug failures 4 +/- 2. Left ventricular function was severely impaired in the majority (ejection fraction 29%; range 14% to 47%) and 18 patients (66%) had a left ventricular aneurysm. Endocardial resection guided by a combination of endocardial activation mapping during tachycardia and fragmentation mapping during sinus rhythm was performed in all patients. All electrically abnormal left ventricular endocardium was excised. Eight patients (29.6%) died within 30 days of surgery. Death was not related to age, time of surgery after infarction, ventricular function, bypass time or type of arrhythmia. Patients requiring emergency surgery had a higher early postoperative mortality rate than did those undergoing planned surgery (43% versus 15%). During a follow-up period of 32 +/- 20 months, there have been no arrhythmic deaths and only three patients (16%) have required antiarrhythmic drug therapy. When required in the early weeks after infarction, surgery for ventricular arrhythmias offers a high cure rate at a risk related to the patient's preoperative arrhythmia frequency, which in turn relates to the risk of arrhythmic death.
Bourke
J P
JP
Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, England.
Hilton
C J
CJ
McComb
J M
JM
Cowan
J C
JC
Tansuphaswadikul
S
S
Kertes
P J
PJ
Campbell
R W
RW
D000328:Adult; D000368:Aged; D004630:Emergencies; D004699:Endocardium / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011300:Preoperative Care; D012008:Recurrence; D013318:Stroke Volume; D015996:Survival Rate; D013610:Tachycardia / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*