Identifying patients at low risk of death from cardiac failure after operation for postinfarct ventricular tachycardia

Background. In unselected patients, cardiac failure accounted for most deat hs after antiarrhythmic operation (ER) for postinfarction ventricular tachy cardia (VT). This study aimed to determine whether patients at low risk of this outcome could be predicted from a retrospective analysis of variables from 100 consecutive ER patients. Methods. Thirteen variables suggested by other researchers as predictive of outcome were analyzed. At the time of study, ER was the only therapy avail able for drug refractory VT. Results, Only emergency ER, wall motion score less than 3 and Killip classi fication were significantly related to death from cardiac failure, The lack of correlation between emergency ER and variables of ER timing, VT less th an 24 hours of ER or VT type implies that the need for emergency ER is also related to ventricular dysfunction. Multivariate analysis identified a gro up at particularly low risk of death with a specificity of 95%. Conclusions. Patients at low risk of death after ER can be identified prosp ectively. In the implantable cardioverter defibrillator era, elective ER is best reserved for such patients. Emergency ER may still be justified in yo unger patients without comorbidity who will die of VT without it. (C) 1999 by The Society of Thoracic Surgeons.