Sequential map-guided endocardial resection for ventricular tachycardia improves outcome

Objective: Surgery for ventricular tachycardias late after myocardial infar ction is frequently associated with high mortality including sudden death, and arrhythmia recurrences. We examined our results of sequential map-guide d endocardial resection at normothermia in patients with ventricular tachya rrhythmias late after myocardial infarction to assess the efficacy of this technique as well as the early and long-term outcome. Methods: From 1995 to 1999, 22 patients underwent normothermic sequential map-guided endocardial resection for ventricular tachyarrhythmias late after myocardial infarctio n. Mean age was 61.2 +/- 6.5 years and left ventricular ejection fraction 3 2.5 +/- 8.7%. Adjunctive procedures included endoventricular patch repair o f left ventricular aneurysm in 21 patients, coronary artery bypass grafting in 15 patients, and mitral valve replacement in one patient. Inducibility of ventricular tachycardia was evaluated postoperatively and patients were treated with sotalol or defibrillator implantation. Results: The intraopera tive number of inducible different ventricular tachycardia morphologies was 4.0 +/- 2.7. More than one mapping-resection sequence was needed in ten pa tients. In only one patient, sustained ventricular tachycardia was induced postoperatively, sotalol was not tolerated and a defibrillator was implante d. Five patients with inducible non-sustained ventricular tachycardia becam e non-inducible while on sotalol. There was one operative death (4.5%). Dur ing a median follow-up of 26 (1-62) months, there were neither cardiac deat hs nor ventricular tachycardia recurrences. Two patients died from non-card iac causes. Cumulative probability of survival at 5 year was 0.83 +/- 0.09. Conclusions: Sequential map-guided endocardial resection at normothermia w as associated with low operative mortality and low postoperative inducibili ty of sustained ventricular tachycardia. The selected therapeutic approach resulted in freedom of arrhythmia recurrence and cardiac mortality includin g sudden death, during long-term follow-up. (C) 2001 Elsevier Science B.V. All rights reserved.