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Role of mapping-guided surgery in patients with recurrent ventricular tachycardia
1Department of Cardiology, University Hospital Hannover, Germany.
Insights
Ventricular tachycardia (VT) surgery showed a lower recurrence rate in patients with coronary artery disease (9%) compared to those without (55%). However, mortality rates were similar between groups, highlighting the complexity of VT treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Recurrent ventricular tachycardia (VT) poses significant management challenges.
- Surgical interventions are considered for refractory VT.
- Assessing the efficacy of VT surgery in different patient populations is crucial.
Purpose of the Study:
- To evaluate the effectiveness of ventricular tachycardia (VT) surgery.
- To compare outcomes in patients with and without coronary artery disease (CAD).
Main Methods:
- A study of 108 patients with recurrent VT.
- Group I (97 patients) with CAD underwent subendocardial resection, with 12 also receiving cryoablation.
- Group II (11 patients) without CAD received cryoablation alone.
Main Results:
- Overall mortality was 30% in Group I and 18% in Group II (p=0.33).
- Nonfatal VT recurrence was significantly lower in Group I (9%) versus Group II (55%) (p<0.01).
- In Group I, posterolateral VT origin was associated with higher mortality.
Conclusions:
- Ventricular tachycardia (VT) surgery, particularly subendocardial resection, is effective in reducing recurrence in CAD patients.
- Cryoablation alone for non-CAD VT patients resulted in higher recurrence rates.
- VT origin influences surgical outcomes in CAD patients.
Abstract:
To assess the value of ventricular tachycardia (VT) surgery 108 patients with recurrent episodes of VT were studied. There were 97 patients with coronary artery disease (group I) and 11 patients without coronary artery disease (group II). All patients in group I underwent subendocardial resection; 12 patients also underwent cryoablation. Cryoablation alone was performed in all patients in group II. During a mean follow-up period of 40 +/- 27 months, 29 patients (30%) in group I and two patients (18%) in group II died (p = 0.33). There were nine patients (9%) in group I and six patients (55%) in group II who had nonfatal recurrences of VT after surgery (p less than 0.01). In group I, there was a higher mortality rate among patients who had VT of posterolateral origin (14 of 31 patients; 45%) compared with 3 of 11 patients (28%) who had VT of anterolateral origin, 1 of 8 patients (12%) who had VT of inferoseptal, and 11 of 39 (29%) patients who had VT of anteroseptal origin. None of the eight patients with two distinct origins of VT died.