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Evolving patterns in the surgical treatment of malignant ventricular tachyarrhythmias
J A Elefteriades1, L A Biblo, W P Batsford
1Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06510.
Insights
Endocardial resection remains a valuable treatment for intractable ventricular arrhythmias, offering greater long-term benefits than automatic implantable cardioverter defibrillators (AICDs) with similar risks.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Surgical Interventions
Background:
- The automatic implantable cardioverter defibrillator (AICD) is a common treatment for ventricular arrhythmias.
- The efficacy and safety of AICDs have led to decreased use of electrophysiologically directed endocardial resection.
- Intractable ventricular arrhythmias require effective therapeutic options.
Purpose of the Study:
- To compare the safety and efficacy of AICD procedures versus endocardial resection for intractable ventricular arrhythmias.
- To evaluate short-term mortality, need for antiarrhythmic agents, and long-term survival rates.
- To determine the continued value of endocardial resection as a treatment option.
Main Methods:
- A retrospective review of 127 patients who underwent either AICD implantation or endocardial resection over a 6-year period.
- Analysis of 30-day mortality, need for antiarrhythmic medications, and survival rates at 2 and 4 years.
- Comparison of outcomes between the AICD group and the endocardial resection group.
Main Results:
- Thirty-day mortality rates were comparable between AICD procedures (5.6%) and endocardial resection (11.8%).
- Patients undergoing resection required fewer antiarrhythmic agents (33%) compared to AICD recipients (61%).
- Two-year survival was 78% for resection and 72% for AICD; 4-year survival remained 78% for resection, with no late sudden deaths in this group.
Conclusions:
- Endocardial resection is a viable and effective alternative for managing intractable ventricular arrhythmias.
- Resection offers greater overall benefit with only a slightly increased risk compared to AICDs.
- Electrophysiologically directed endocardial resection should remain a consideration in treatment strategies.
Abstract:
The advent of the automatic implantable cardioverter defibrillator (AICD), generally viewed as a safe and effective intervention, has in some measure discouraged the use of electrophysiologically directed endocardial resection for intractable ventricular arrhythmias. We reviewed the records of 127 patients undergoing either AICD procedures or resection over a 6-year period. Thirty-day mortality was 5.6% (5/89 patients) for all AICD procedures, 10.7% (3/28) for AICD placement plus coronary artery bypass grafting, and 11.8% (4/34) for resection. These mortality figures are not significantly different. Patients undergoing resection were less likely to require antiarrhythmic agents than patients given an AICD (33% versus 61%). Survival at 2 years was 78% in the resection group and 72% in the AICD group. Survival at 4 years was still 78% in the resection group. Only 1 late sudden death occurred in the AICD group and none in the resection group. We conclude that resection continues to be a valuable alternative, offering a greater overall benefit at only slightly increased risk.