EPICARDIAL NEODYMIUM - YAG LASER PHOTOCOAGULATION OF VENTRICULAR-TACHYCARDIA WITHOUT VENTRICULOTOMY IN PATIENTS AFTER MYOCARDIAL-INFARCTION

Background Surgical ablation of ventricular tachycardia (VT) after myo cardial infarction has been reported by different endocardial approach es. The ventriculotomy may increase mortality of the procedure. Method s and Results We report on nine patients who suffered from recurrent V T in the late post-myocardial infarction period. Significant stenoses were detected in all patients. The mean left ventricular ejection frac tion was 43.1+/-8.3%. Left ventricular scar (n=9) was seen. The mean N YHA class was 2.2+/-0.4. Sustained VT (mean cycle length, 293+/-52 ms) occurred spontaneously (n=9) and could be induced reproducibly. Cathe ter mapping detected a prematurity of -42+/-13 ms in six patients. Cli nical VT was inducible during surgery in seven patients. Middiastolic potentials were detected from the epicardial surface (n=3), and premat ure potentials were found (n=8 with prematurity of -108+/-46 ms). Appl ication of neodymium/yttrium/argon/garnet (Nd:YAG) laser energy to ear ly epicardial activation terminated the arrhythmia (n=7). Ventriculoto my was not performed. Seven patients have been free of VT for a mean f ollowup period of 17+/-11 months; one patient relapsed and was treated with an implantable cardioverter-defibrillator, as was a second patie nt with inducible VT after surgery. Conclusions Surgical Nd:YAG laser photocoagulation of VT on the epicardial surface of the heart in post- myocardial infarction patients without ventriculotomy is safe and has a high success rate. At the present time, this method is recommended i n patients with sustained and tolerated VT who need bypass surgery. Th is is the first report on epicardial laser ablation of VT in postmyoca rdial infarction VT.