OPERATION FOR RECURRENT VENTRICULAR-TACHYCARDIA - PREDICTORS OF SHORT-TERM AND LONG-TERM EFFICACY

The success of ventricular operation in ablating drug-refractory ventr icular tachycardia secondary to ischemic heart disease varies with sur gical technique, the presence of certain identified risk factors, and patient selection biases. Forty-eight patients with drug-refractory ve ntricular tachycardia secondary to ischemic heart disease underwent di rected ventricular operation. Ah patients had previous myocardial infa rction, and 46 of 48 patients had a left-ventricular aneurysm. Mapping was done in 81% of patients. Patients underwent a combination of sube ndocardial resection, aneurysmectomy, and cryoablation. The operative mortality rate was 8%. Age greater than 65 years was the only risk fac tor for operative mortality. Forty-one patients underwent postoperativ e programmed electrical stimulation. In 26 patients (63%) tachycardia was noninducible, whereas it was inducible in 15 patients (37%). Stepw ise logistic regression identified septal and inferior focus location as the most significant predictors of outcome. Septal focus location w as a significant (p = 0.008) predictor of surgical success whereas inf erior focus location was a significant (p = 0.015) predictor of surgic al failure. Other identified independent risk factors for surgical fai lure were (1) use of cardioplegia, (2) lack of a completed intraoperat ive endocardial map, and (3) decreased ejection fraction. This generat ed model to predict success or failure had a sensitivity of 93.3% and a specificity of 92.4%. The success of ventricular operation is affect ed by the presence of certain risk factors. In the management of those patients at high risk for failure, other surgical options such as the placement of implantable cardioverter-defibrillator electrode patches at the time of ventricular operation or the alternative placement of a palliative implantable cardioverter-defibrillator should be consider ed.