Surgical management of life-threatening arrhythmias

Map-guided direct surgery was performed in 408 patients with various tachyarrhythmias at our institution. Of 355 patients with WPW syndrome, 5 had experienced an episode of ventricular fibrillation (Vf), 180 had atrial fibrillation with a rapid ventricular response, and 76 had other heart diseases. These patients were regarded as being at risk for sudden death. The shortest R-R interval between pre-excitation (215 +/- 38 msec) was significantly shorter than the antegrade effective refractory period (270 +/- 35 msec) of accessory pathway (ACP) in 126 patients (p less than 0.001). The shortest R-R interval of the patients with Vf was 200 msec or less. The ACP was successfully interrupted in 334 patients (94%). Simultaneous operations were carried out for other types of heart disease in 58 patients. Surgery was performed in 43 patients with ventricular tachycardia (VT), 39 non-ischemic and 4 ischemic, who were unresponsive to conventional antiarrhythmic therapy. Three patients with non-ischemic VT required emergency operation. The principle of surgery for non-ischemic was excision plus cryocoagulation of right ventricle and incision plus cryocoagulation of left ventricle. Thirty non-ischemic patients (76.9%) were cured of VT, while 7 still take medication prophylactically (3 for sporadic premature beats, and 4 for VT). All 4 patients with ischemic VT were also treated successfully. In conclusion, our results demonstrate the therapeutic value of map-guided direct surgery for life-threatening arrhythmias.