ARRHYTHMOGENIC VENTRICULAR ANEURYSMS UNRELATED TO CORONARY-ARTERY DISEASE

Malignant ventricular tachycardia occurs most frequently in patients w ith coronary artery disease who have had a previous myocardial infarct ion and in whom a ventricular aneurysm subsequently develops in the sc arred section of myocardium. Ventricular tachycardia in the presence o f normal coronary arteries and a left ventricular aneurysm is unusual and can be refractory to medical therapy. We retrospectively reviewed our experience of 10 patients treated at our institution from 1983 to 1993. Age ranged from 22 to 76 years, and all patients presented with sustained ventricular tachycardia. All patients underwent complete ele ctrophysiologic testing. Cardiac catheterization was performed in 9 pa tients, and each had normal coronary artery anatomy without evidence o f significant fixed lesions. A left ventricular aneurysm, diagnosed by either echocardiography, thoracic cine computed tomography or magneti c resonance imaging, or ventricular angiography was present in all pat ients. Ventricular tachycardia could not be suppressed pharmacological ly in 7 of 10 patients using multiple agents including procainamide, q uinidine, flecanide, tocainide, propaferone, and amiodarone. Six patie nts were treated surgically by intraoperative electrophysiologic mappi ng, endocardial resection of foci, and left ventricular aneurysmectomy . An implantable cardiac defibrillator device was implanted in 2 patie nts. One patient died on the second postoperative day after simultaneo us mapping-guided aneurysmectomy and implantable cardioverter defibril lator placement. There was one late postoperative death. All other sur gically treated patients had postoperative electrophysiologic studies demonstrating no inducible ventricular tachycardia, and these patients remain without antiarrhythmic therapy in follow-up extending from 29 to 86 months (mean, 56 months). Surgical pathologic examination showed nonspecific myocardial scarring and fibrosis in the aneurysm walls, w hich ranged in size from small apical to large broad-based basilar ane urysms with a cavity volume equal to that of the left ventricle. Our e xperience supports surgical therapy for medically refractory arrhythmo genic left ventricular aneurysms unrelated to coronary artery disease.