Intraoperative mapping-guided argon laser ablation of malignant ventricular tachycardia.
Intraoperative mapping-guided laser ablation of arrhythmogenic myocardium was performed in 5 patients with refractory sustained ventricular tachycardia (VT). Using a 15-W argon laser coupled to a 300-mu optical fiber, a bloodless laser ventriculotomy was successfully performed in 4 patients with VT. Visually- and mapping-guided endocardial ablation of 7 VT morphologic patterns was performed. Five of the 7 sites of VT origin were unresectable using standard resection techniques. Postoperatively, spontaneous and inducible VT was suppressed in all patients (without antiarrhythmic drugs in 4 patients and with a previously ineffective drug 1 patient). Mean pulmonary capillary wedge pressure, cardiac index and left ventricular ejection fraction were unchanged (p greater than 0.2) from preoperative values. Mean maximal creatinine kinase-MB isoenzyme concentration was 139 +/- 75 IU. All patients were New York Heart Association functional class II at discharge. During follow-up, no spontaneous arrhythmia has recurred in any patient. Thus, intraoperative argon laser ablation is effective for VT ablation alone or in conjunction with standard surgical resection techniques.
D000368:Aged; D004594:Electrophysiology / Q000379:methods; D005069:Evaluation Studies as Topic; D006801:Humans; D007432:Intraoperative Period; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013610:Tachycardia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*