title: Surgical cryoablation for ventricular tachyarrhythmia arising from the left ventricular outflow tract region.
abstract: BACKGROUND
  Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) region can be inaccessible for ablation because of epicardial fat or overlying coronary arteries.
  
  
  OBJECTIVE
  We describe surgical cryoablation of this type of VA.
  
  
  METHODS
  From March 2009 to 2014, 190 consecutive patients with VAs originating from the LVOT underwent ablation at our institution. Four patients (2%) underwent surgical cryoablation for highly symptomatic VAs after failing catheter ablation.
  
  
  RESULTS
  In all patients, endocardial or percutaneous epicardial mapping was consistent with origin in the LVOT. In 2 patients, the points of earliest activation during VAs were marked with a bipolar pacing lead in the overlying cardiac vein for guidance during surgery. Surgical cryoablation was successful in 3 of the 4 patients. The fourth patient subsequently had successful endocardial catheter ablation. During a mean follow-up of 22 ± 16 months (range 4-42 months), all patients showed abolition of or marked reduction in symptomatic VA. However, 1 patient subsequently required percutaneous intervention to the left anterior descending coronary artery; another developed progressive left ventricular systolic dysfunction caused by nonischemic cardiomyopathy; and a third patient underwent permanent pacemaker implantation because of complete atrioventricular block after concomitant aortic valve replacement.
  
  
  CONCLUSIONS
  Surgical cryoablation is an option for highly symptomatic drug-resistant VAs emanating from the LVOT region. Despite extensive preoperative mapping, the procedure is not effective for all patients, and coronary injury is a risk.
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Eue-Keun
authors.initials: EK
authors.lastname: Choi
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Kaity Y
authors.initials: KY
authors.lastname: Lin
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Barbhaiya
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Baldinger
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: rjohn2@partners.org.
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
mesh_terms: D000328:Adult; D003452:Cryosurgery; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000601:surgery*
keywords: Left ventricular outflow tract; Surgical cryoablation; Ventricular tachycardia; Ventricular tachycardia ablation