Recurrent ventricular tachycardia associated with postinfarction aneurysm. Results of left ventricular reconstruction

Left ventricular reconstruction was used to control recurrent ventricular tachycardia in 19 patients (16 male), mean age of 56 years, with postinfarction anteroseptal aneurysms. The "origin" of recurrent ventricular tachycardia was not determined because the ventricular tachycardia induced by programmed stimulation produced hemodynamic deterioration in all patients. The average ejection fraction was 30.7% +/- 10.1%. In the left ventricular reconstruction technique, the plication of the aneurysmal septum and the reduction of the orifice of the left ventricular cavity after aneurysmal resection with a purse-string suture appear important to prevent the functioning of the reentry circuits. There was one death in the immediate postoperative period. The mean ejection fraction was 47.8% +/- 8.1% (p less than 0.001). The postoperative programmed stimulation induced ventricular tachycardia in only one patient. There were two late deaths. The other 16 patients are asymptomatic (five with antiarrhythmic drugs) in functional class I and without recurrence of ventricular tachycardia. Left ventricular reconstruction is an acceptable technique that changes the spatial orientation in eventual tachycardia circuits. Hence this technique is an alternative for long-term control of the right ventricular tachycardia associated with postinfarction anteroseptal aneurysm without previous electrophysiologic mapping.