Surgical interventions in ischemic ventricular tachyarrhythmias--endocardial resection or implanted cardioverter/defibrillator.
The surgical therapy of ventricular tachyarrhythmias (VTA) in ischemic heart disease is attracting attention, since current medical therapies are showing limited long-term efficacy. The curative concept of electrophysiologically guided endocardial resection (ER) and palliation with the implantable cardioverter/defibrillator (ICD) are compared retrospectively. From 1980-1992, 121 patients (55 +/- 9 years, 108 males, 13 females) underwent ER and 203 patients (59 +/- 9 years, 195 males, 8 females) received an ICD for ischemic VTA. Concomitant coronary revascularization was performed in 38/121 patients with ER (31%) and in 62/203 patients (31%) with ICD. Perioperative mortality was 8% (10/121 patients) for ER and 5% (10/203 patients) for ICD (P = n.s.). Hundred eleven patients with ER (mean follow-up 41 +/- 37 months) and 193 with ICD (mean follow-up 22 +/- 20 months) were available for survival analysis: freedom from sudden death was comparable for the two groups at 1 year (99% for ICD, and 94% for ER) and at 5 years (90% for ICD and 90% for ER) (P = n.s.). Freedom from cardiac death also showed no differences between the groups at 1 year (94% for ICD, and 84% for ER) and at 5 years (74% for ICD and 74% for ER) (P = n.s.). Left ventricular function, indicated by left ventricular ejection fraction, was comparable (34 +/- 9% in ER, 30 +/- 11% with ICD) (P = n.s.) in the two groups. The linearized incidence of DC-shocks was 10.3/year in ICD patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Fieguth
H G
HG
Department of Surgery, Hannover Medical School, Germany.
Trappe
H J
HJ
Wahlers
T
T
Siclari
F
F
Frank
G
G
Borst
H G
HG
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D004699:Endocardium / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology