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[Surgery of refractory ischemic arrhythmia].
M Viganò1, A Graffigna, G Salerno
1Divisione di Cardiochirurgia, I.R.C.C.S. Policlinico S. Matteo, Pavia.
Giornale Italiano Di Cardiologia
|March 1, 1992
Summary
Electrically guided surgical ablation (EGSA) is effective for refractory ventricular tachycardia, though low ejection fraction predicts early mortality. EGSA shows lower operative mortality than other procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Context:
- Refractory ventricular tachycardia (VT) in ischemic heart disease poses significant clinical challenges.
- Surgical interventions have evolved to manage this complex condition.
Purpose:
- To evaluate the outcomes of different surgical treatments for refractory ventricular tachycardia due to ischemic heart disease.
- To identify predictors of mortality and recurrence after these procedures.
Summary:
- 138 patients with ischemic heart disease and refractory VT underwent treatment: 117 with electrically guided surgical ablation (EGSA), 14 with automatic implantable cardioverter-defibrillators (AICD), and 8 with heart transplantation.
- EGSA had an 11.4% operative and 13.4% late mortality. Preoperative ejection fraction <25% predicted early mortality (32% vs 0%).
- EGSA demonstrated lower operative mortality (8.5%) compared to aneurysmectomy or visually guided procedures (75%). AICD and heart transplantation showed favorable survival rates.
Impact:
- Electrically guided surgical ablation is a viable treatment option for refractory VT, with survival rates improving with higher ejection fraction.
- Identifying high-risk patients (LVEF <25%) allows for tailored management strategies.
- This study highlights the importance of guided procedures in reducing operative mortality for VT ablation.