D. Lacroix et al., VALUE OF MAPPING IN SURGICAL-TREATMENT OF VENTRICULAR-TACHYCARDIA, Archives des maladies du coeur et des vaisseaux, 89, 1996, pp. 109-113
Surgery may be proposed for patients with a localised aneurysm or akin
esia for treatment of monomorphic ventricular tachycardia resistant to
antiarrhythmic therapy after myocardial infarction. The multiplicity
of tachycardia forms in the same patient, the variability of their mec
hanism which is not necessarily limited to the subendocardia layers, r
equire mapping to guide the surgeon in the destruction of the anatomic
al substrates. In a series of 57 ventricular tachycardias recorded in
17 patients with myocardial infarction the authors demonstrated that a
system of computerised mapping of the epicardial and endocardial regi
ons optimised the results of this form of surgery. Mapping localised,
sometimes at a distance from the scar, classical subendocardial reentr
y, implicated on occasion the mitral papillary muscle in the mechanism
or a tachycardia in cases of inferior or lateral infarction and local
ised the reentry in the epicardium of the lower layers of the septum.
The identification of these ''typical'' mechanisms significantly impro
ves the number of patients without inducible arrhythmias after surgery
(from 50 to 87% in the authors' experience), without changing the ope
rative mortality. The only really curative approach because of the lim
itations of catheter ablation, this surgery is a complementary method
to implantable defibrillators in the management of post-infarction ven
tricular tachycardia.