SURGICAL-TREATMENT OF VENTRICULAR-TACHYCARDIA

Despite the excellent results achieved with the endocardial resection procedure in the management of patients with life-threatening ventricu lar tachycardia. Most surgical electrophysiology teams have experience d a decline in the number of direct operations performed for life-thre atening ventricular tachycardia. This is probably due to the widesprea d use of thrombolytic therapy during the acute phase of infarct format ion. But also to the advent of implantable cardioverter-defibrillators that are increasingly sophisticated, easy to use and effective. Their increased use over the past few years is related to the belief that d irect operations for the eradication of ventricular tachycardia foci b ear a high operative mortality rate. However, today the operative mort ality is less than 5%, and long term survival is up to 85% at 5 years with an extremely low incidence of ventricular tachycardia recurrence and sudden death. We report the results obtained in our first 100 pati ents in whom ventricular tachycardia surgical ablation was guided by c omputerized mapping of both the endocardium and epicardium. A particul ar type of ventricular tachycardia activation pattern was found to be associated with a higher rate of electrical failure due to a deep sept al substratum. Appropriate management of this condition may further de crease the rate of ventricular tachycardia reinducibility and long ter m return of ventricular tachycardia to a level yet unachieved by any o ther therapeutic modality. The results of catheter ablation are promis ing, but access to intramural substrates remains unresolved. In patien ts with sustained monomorphic ventricular tachycardia associated with a discrete akinetic area of the left ventricle, surgery offered as a l ast resort is less likely to produce favourable results and the decisi on of its use should therefore be taken early before unjustified drug trials go on.