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[Variants of surgical treatment of ventricular tachycardia]
Insights
Managing ventricular tachycardias (VTs) effectively involves electrophysiological studies, cardioverter-defibrillator implantation, or cardiac transplantation. Treatment choice depends on underlying heart disease and patient factors for improved outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Context:
- Ventricular tachycardias (VTs) pose significant risks, often stemming from coronary heart disease (82%) or non-ischemic heart disease (18%).
- Managing VTs requires tailored therapeutic strategies based on the underlying etiology and patient condition.
Purpose:
- To present the comprehensive management strategies for ventricular tachycardias at the Hannover++ Surgery Center.
- To evaluate the outcomes of different interventions including electrophysiological studies, cardioverter-defibrillator implantation, and cardiac transplantation for VTs.
Summary:
- Electrophysiological studies guided radical operations in 122 patients, with early mortality at 9% and relapses in 5% (coronary) and 46% (non-coronary) of cases.
- Automatic cardioverter-defibrillators were implanted in 92 patients (mean ejection fraction 32%), showing 5% early and 19% late mortality.
- Cardiac transplantation was performed in 12 patients (mean ejection fraction 17%), with 17 surviving 3-36 months, indicating its efficacy in severe cases.
Impact:
- Electrophysiological support surgery is highly effective for VTs.
- Cardioverter-defibrillator implantation serves as a palliative measure for ventricular dysfunction without a clear VT substrate.
- Cardiac transplantation is recommended for young patients with progressive disease, with cardioverter-defibrillator as an alternative if transplantation is not feasible.
Abstract:
The paper presents the practice of the Hannover++ Surgery Center (FRG) in managing ventricular tachycardias: 122 patients underwent a radical operation by using electrophysiological studies, 92 patients were implanted an automatic cardioverter/defibrillator, 12 had homotopic cardiac transplantation. Coronary heart disease was present in 82%, non-ischemic heart disease was seen in 18%. The outcomes of operations with electrophysiological studies were as follows: deaths were 9% in early periods, relapses occurred in 5% of patients with coronary heart disease and in 46% of non-coronarogenic diseases. The cardioverter/defibrillator was implanted in 71 patients with coronary heart disease and 21 patients with non-coronarogenic diseases. The mean ejection fraction was 32%. The early and late mortality rates were 5 and 19%%, respectively. Out of 19 patients who had undergone transplantation, 17 were alive in follow-ups of 3 to 36 months. The ejection fraction before transplantation averaged 17%. The surgery for ventricular tachycardias with electrophysiological support is a highly effective method of therapy. The implantation of a cardioverter/defibrillator is regarded as a palliative intervention in patients with ventricular malfunction in the absence of an electrophysiological tachycardia substrate or in the presence of polymorphic tachycardia. Cardiac transplantation should be performed chiefly in young patients with evolving major disease. The transplantation may be replaced by implantation of a cardioverter if the former is impracticable or will be performed in future.