[The surgical treatment of sustained ventricular tachycardias. The short- and midterm results in the era of the implantable defibrillator and the heart transplant].
BACKGROUND
The surgical treatment of refractory ventricular tachycardia has been shown to be effective. Its use has been limited by a high perioperative mortality.


OBJECTIVE
To study the extent to which the introduction of new therapeutic options, i.e. the implantable defibrillator and cardiac transplantation, improves patient selection and results of direct antiarrhythmic surgery.


METHODS
We analyzed 24 consecutive patients operated upon for ventricular tachycardia (study population). At the same time, 42 patients were treated with implantable defibrillator and 11 patients, with symptomatic ventricular arrhythmias, underwent cardiac transplantation (reference population).


RESULTS
The clinical characteristics of the study population (age, functional class, ejection fraction) were significantly different from those of both reference groups. Nine patients (38%) were operated upon because of electrical instability and/or contraindication for other therapeutic options despite of having criteria of high surgical risk. There was one perioperative death (4.2%) and no other early arrhythmic recurrences. Persistence of inducibility occurred in 5 cases (22%). During follow up (35 +/- 22 months) there was a single arrhythmic recurrence. Three patients died of nonarrhythmic causes. Presently, 16 patients are in I or II NYHA functional class.


CONCLUSIONS
1) Direct surgery remains as a useful tool in the treatment of ventricular tachycardia; 2) clinical differences among groups caused by the individual selection of the three therapeutic options preclude comparison of their results, and 3) the introduction of other therapeutic approaches, although resulting in only partial improvement of patient selection, leads to acceptable short and mid-term results of direct antiarrhythmic surgery.
Bueno Zamora
H
H
Laboratorio de Electrofisiología, Hospital General Gregorio Marañón, Madrid.
Almendral Garrote
J
J
Albertos Salvador
J
J
Arenal Maíz
A
A
Pérez Villacastín
J
J
Pastor Fuentes
A
A
Arcas Meca
R
R
Delcán Domínguez
J L
JL
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors
Tratamiento quirúrgico de las taquicardias ventriculares sostenidas. Resultados a corto y medio plazo en la "era" del desfibrilador implantable y del transplante cardíaco.