[Endocardial fulguration for the treatment of ventricular tachycardia. Experience with 69 cases]

Between 1983 and 1989, 69 patients underwent endocardial fulguration for drug-resistant VT which had several relapses per month, or were incessant. The etiologies were an old myocardial infarction, (25 cases) arrhythmogenic right ventricular dysplasia, (19 cases) dilated cardiomyocathy, (9 cases) left fascicular tachycardia, (9 cases) 5 right septal idiopathic tachycardia, and 2 congenital heart disease. The ejection fraction ranged between 12 and 30% in 25 cases. VT originated in 32 patients in the right ventricle, 31 in the left, and 6 had fulguration in both ventricles. 41 patients had 1 session, 22 needed 2, 4 had three sessions and 2 had 4. Five patients died during the procedure, four of low output, and three of them before the shocks. One died of tamponade. Two others had tamponade and were successfully drained. Four patients died during the first 3 months of preexisting heart failure without VT relapse. The remaining patients have a mean follow-up of 32 months, ranging from 3 to 72 months. 32 patients are off drug and had no relapse. 23 had early relapses, and are controlled by previously ineffective drugs. However 3 of these had a late sudden death (4, 14 and 22 months). 9 are treated with a combination of drug not tested before. The success rate ranges from 60% in septal VT to 74% in ARVD, 86% in MI and 100% in idiopathic left fascicular VT. The success rate increases with the number of sessiones. Fulguration alone, or combined with pharmacological agents can be considered as an effective therapy for VT, despite that it is neither simple, nor harmless.