FULGURATION AND RADIOFREQUENCY CATHETER A BLATION OF VENTRICULAR-TACHYCARDIA

Eighty-nine cases of ventricular tachycardia, resistant to antiarrhyth mic therapy, were treated over a 10 year period by high energy D ablat ion (fulguration). This series included 37 cases of myocardial infarct ion with a mean ejection fraction of 30%. The mean follow-up period of the survivors was 61 months and clinical efficacy was 87.9%. Twenty-t hree cases of arrhythmogenic right ventricular dysplasia, aged 40 year s, and with an ejection fraction of 57%, followed up for 71 months, ha d a clinical efficacy of 83%. Twelve patients had verapamil sensitive (fascicular) ventricular tachycardia. Their age was 30, their ejection fraction 65%, the follow-up period 55 months, and the clinical effica cy was 100%. Ten patients had primary dilated cardiomyopathy. Their ag e was 35, their ejection fraction 23%, the follow-up period of 38 mont hs with a clinical efficacy of 80%. Four patients, aged 21, had operat ed congenital heart disease with an ejection fraction of 60%, a follow -up of 36 months and a clinical efficacy of 100%. Finally, 3 patients had idiopathic infundibular ventricular tachycardia. Their age was 36, the ejection fraction 62%, the follow-up period was 72 months and the clinical efficacy was 67%. Non lethal complications were observed in 16% of cases, mainly haemopericardium requiring pericardocentesis in 4 .5% of cases. The operative mortality and in the month following ablat ion was 9.2%, observed mainly during the learning period. These result s show that fulguration is not without risk, but in skilled hands, it gives remarkable results in the majority of cases. It continues to be used in ventricular tachycardia resistant to radiofrequency current, o bserved in over half the cases, in a preliminary series of 41 patients .