New directions in surgical therapy of arrhythmias

The success of the radiofrequency catheter ablation procedure for most type s of supraventricular and ventricular tachycardia, particularly in young pa tients, largely eliminated the role of surgical therapy of arrhythmias. How ever, there remains a subset of arrhythmia patients in whom the catheter ap proach has not been successful and types of arrhythmias with high recurrenc e rates following initially successful catheter ablation procedures where s urgery can provide more definitive therapy. In addition, the concepts of ab lation therapy can be successfully incorporated into the concomitant repair of complex congenital heart disease, resulting in single-stage therapy for structural and rhythm abnormalities. Prospectively, knowledge of the role of anatomic barriers as substrates for future reentrant arrhythmia circuits provides the opportunity to alter these circuits prophylactically at the t ime of initial surgical repair of congenital heart disease in an attempt to avoid the late development of tachycardia. This article describes our expe rience during the past decade with 71 patients undergoing arrhythmia surger y using this approach.