Surgery for postinfarction ventricular tachycardia in the pre-implantable cardioverter defibrillator era: early and long term outcomes in 100 consecutive patients

Objective-To report outcome following surgery for postinfarction ventricula r tachycardia undertaken in patients before the use of implantable defibril lators. Design-A retrospective review, with uniform patient selection criteria and surgical and mapping strategy throughout. Complete follow up. Long term dea th notification by OPCS (Office of Population Censuses and Statistics) regi stration. Setting-Tertiary referral centre for arrhythmia management. Patients-100 consecutive postinfarction patients who underwent map guided e ndocardial resection at this hospital in the period 1981-91 for drug refrac tory ventricular tachyarrhythmias. Results-Emergency surgery was required for intractable arrhythmias in 28 pa tients, and 32 had surgery within eight weeks of infarction ("early"). Surg ery comprised endocardial resections in all, aneurysmectomy in 57, cryoabla tions in 26, and antiarrhythmic ventriculotomies in 11. Twenty five patient s died < 30 days after surgery, 21 of cardiac failure. This high mortality reflects the type of patients included in the series. Only 12 received anti arrhythmic drugs after surgery. Perioperative mortality was related to preo perative left ventricular function and the context of surgery. Mortality ra tes for elective surgery more than eight weeks after infarction, early surg ery, emergency surgery, and early emergency surgery were 18%, 31%, 46%, and 50%, respectively. Actuarial survival rates at one, three, five, and 10 ye ars after surgery were 66%, 62%, 57%, and 35%. Conclusions-Surgery offers arrhythmia abolition at a risk proportional to t he patient's preoperative risk of death from ventricular arrhythmias. The l ong term follow up results suggest a continuing role for surgery in selecte d patients even in the era of catheter ablation and implantable defibrillat ors.