[Surgery for arrhythmia in patients with therapy-resistant ventricular tachycardia].
We reviewed the data of 42 consecutive patients (mean age 55 +/- 12 years) who underwent surgery for control of recurrent drug-refractory ventricular arrhythmia. A history of myocardial infarction was present in 38 patients, 4 patients had congenital heart disease (2 aneurysms, 1 right ventricular dysplasia, 1 hamartoma). The mean LV ejection fraction was 40 +/- 14%. At preoperative electrophysiologic study, ventricular tachycardia was inducible in 32 of 33 patients. The mean heart rate was 188/min. A mean of 3.3 +/- 2.1 antiarrhythmic drug trials were ineffective. The most frequently performed surgical procedure (n = 36) was visually guided subendocardial resection, alone or in combination with cryothermal ablation. In 30 patients additional aneurysmectomy was performed. A mean of 1.9 +/- 1.4 coronary arteries in 32 patients were bypassed. The overall in-hospital mortality (30 days) was 9.5% (1 arrhythmic death, 1 pump failure, 1 sepsis, 1 hemorrhagic shock). We found 2 significant (p < 0.05) predictors of perioperative mortality: recent myocardial infarction and patient's age. During a mean follow-up of 33 months (range 1 to 90), there were 3 sudden cardiac deaths and 6 nonfatal recurrences of ventricular tachycardia which were subsequently prevented with antiarrhythmic drug therapy. Thus, the overall success in control of arrhythmia was 92%, in 59% by surgery alone. Survival was 79% at 2 years after surgery and 63% at 5 years. We conclude that patients who have successful subendocardial resection and aneurysmectomy for control of ventricular arrhythmia have an excellent chance of arrhythmia-free survival and a relatively good prognosis.
Candinas
R
R
Departement Innere Medizin, Kardiologie, Universitätsspital Zürich.
Welter
M
M
Gloor
H O
HO
Amann
F W
FW
von Segesser
L
L
Turina
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D017115:Catheter Ablation / Q000379:methods; D001026:Coronary Artery Bypass; D006322:Heart Aneurysm / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D011379:Prognosis; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000601:surgery
Rhythmuschirurgie bei Patienten mit therapierefraktären Kammertachykardien.