title: Encircling endocardial cryoablation for ventricular tachycardia after myocardial infarction: experience with 33 patients.
abstract: Encircling endocardial cryoablation, consisting of circumferential cryoablation of the infarct scar, can be curative in selected patients with ventricular tachycardia (VT). We describe our experience with and long-term outcome in 33 patients undergoing this procedure. The interval between myocardial infarction and the onset of tachycardia varied from 2 weeks to 22 years (mean 38 +/- 63 months and median 3 months). All patients had a left ventricular aneurysm (anterior in 20, posterior in 12, and lateral in 1) and significant coronary artery disease. Fourteen patients had clinical evidence of heart failure preoperatively. Twenty-eight patients had sustained monomorphic VT (incessant in 3); 3 had polymorphic or nonsustained tachycardia; 2 had primary ventricular fibrillation; and 1 had associated Wolff-Parkinson-White syndrome. Surgery was undertaken after failed drug therapy and consideration of left ventricular anatomy and function. At surgery, 32 patients had encircling endocardial cryoablation, and 1 patient had partial right ventricular free-wall disconnection (right ventricular infarct). Thirteen patients underwent concomitant coronary artery bypass grafting. An implantable cardioverter defibrillator (ICD) was implanted in 2 patients and prophylactic ICD patches in 1. One patient died postoperatively; 3 had recurrent VT perioperatively; 1 was treated with amiodarone; and 2 had ICD implantation. During long-term follow-up (mean 5 years), all patients who were free of tachycardia at discharge remained alive and free of arrhythmias or syncope. The patient receiving amiodarone sustained a cardiac arrest subsequently and received an ICD implant. One patient with an ICD continued to receive appropriate shocks frequently and died 2 years after surgery. Nine patients had congestive heart failure postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, University of Western Ontario, University Hospital, London, Canada.
authors.forename: G M
authors.initials: GM
authors.lastname: Guiraudon
authors.forename: R K
authors.initials: RK
authors.lastname: Thakur
authors.forename: G J
authors.initials: GJ
authors.lastname: Klein
authors.forename: R
authors.initials: R
authors.lastname: Yee
authors.forename: C M
authors.initials: CM
authors.lastname: Guiraudon
authors.forename: A
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000206:Actuarial Analysis; D003452:Cryosurgery; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000601:surgery; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology