[Surgical treatment of post-infarction ventricular tachycardia--a step forward in the therapy]

Surgical treatment of postinfarction ventricular tachycardia on the basis of mapping has replaced to a great extent in the recent decades indirect surgical methods like aneurysmectomy, infarctectomy, and aortocoronary surgery with the use of an extracorporeal circulation machine. The direct surgical methods of treatment of ventricular tachycardia consist in isolation or ablation of the left ventricular arrhythmogenic area identified by arrhythmia mapping before and during the operation. Electrophysiological studies and selection of patients with indications for the operation according to the residual function of the left ventricle after the infarction greatly increased the possibility of the surgical method for the management of ventricular tachycardia and reduced intraoperative and postoperative mortality. Among 52 patients whom we treated by operation in 1985-1989, 86% were freed from arrhythmia; intrahospital mortality was 1.9%, 2-year survival after operation was 90%. These results bear evidence that direct surgical methods for ventricular tachycardia management are an excellent alternative for patients with no contraindications for surgical intervention, in cases in which antiarrhythmic agents are ineffective, even soon after myocardial infarction. Medication with amiodarone or a combination of antiarrhythmic agents, with or without implantation of an automatic cardioverter-defibrillator, is still the best method for treatment of patients with mild residual function of the left ventricle.