Nonpharmacologic therapy of ventricular arrhythmias

Since the first attempt at surgical therapy for VT, much progress has been made in developing techniques for both localization of arrhythmogenic regions as well as their removal or alteration. In the setting of previous myocardial infarction, surgery for VT has evolved from an experiment/last resort procedure to the treatment of choice in many cases, yielding complete freedom from arrhythmia recurrence without adjunctive antiarrhythmic drugs in up to three quarters of operative survivors. Remaining issues in this field include (1) further reduction of operative mortality, perhaps by more careful patient selection (and use of alternative forms of therapy in those judged to be too high risk); (2) better and more accurate mapping techniques to enhance the antiarrhythmic efficacy of surgery; and (3) development of more effective procedures to deal with VT in the setting of cardiomyopathy. Judging from the progress made in the last decade and a half in this field, surgery for VT in many pathologic settings may take on a greater role in the future as further refinements in techniques are realized.