Surgery for postinfarction ventricular tachycardia in the pre-implantable cardioverter defibrillator era: early and long term outcomes in 100 consecutive patients.
OBJECTIVE
To report outcome following surgery for postinfarction ventricular tachycardia undertaken in patients before the use of implantable defibrillators.


METHODS
A retrospective review, with uniform patient selection criteria and surgical and mapping strategy throughout. Complete follow up. Long term death notification by OPCS (Office of Population Censuses and Statistics) registration.


METHODS
Tertiary referral centre for arrhythmia management.


METHODS
100 consecutive postinfarction patients who underwent map guided endocardial resection at this hospital in the period 1981-91 for drug refractory ventricular tachyarrhythmias.


RESULTS
Emergency surgery was required for intractable arrhythmias in 28 patients, and 32 had surgery within eight weeks of infarction ("early"). Surgery comprised endocardial resections in all, aneurysmectomy in 57, cryoablations in 26, and antiarrhythmic ventriculotomies in 11. Twenty five patients died < 30 days after surgery, 21 of cardiac failure. This high mortality reflects the type of patients included in the series. Only 12 received antiarrhythmic drugs after surgery. Perioperative mortality was related to preoperative left ventricular function and the context of surgery. Mortality rates for elective surgery more than eight weeks after infarction, early surgery, emergency surgery, and early emergency surgery were 18%, 31%, 46%, and 50%, respectively. Actuarial survival rates at one, three, five, and 10 years after surgery were 66%, 62%, 57%, and 35%.


CONCLUSIONS
Surgery offers arrhythmia abolition at a risk proportional to the patient's preoperative risk of death from ventricular arrhythmias. The long term follow up results suggest a continuing role for surgery in selected patients even in the era of catheter ablation and implantable defibrillators.
University Department of Cardiology, Freeman Hospital and University of Newcastle upon Tyne NE7 7DN, UK. j.p.bourke@ncl.ac.uk
J P
JP
Bourke
R W
RW
Campbell
J M
JM
McComb
S S
SS
Furniss
J C
JC
Doig
C J
CJ
Hilton
D000783:Aneurysm / Q000601:surgery; D003452:Cryosurgery; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome