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Related Experiment Videos

Extensive endocardial resection for recurrent ventricular tachyarrhythmias.

C P Ratnatunga1, E S Barin, A R Manche

  • 1Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1990
PubMed
Summary

Extensive endocardial resection (EER) effectively treats recurrent ventricular tachyarrhythmias (VT) originating from ischemia. This surgical approach offers a high success rate for ablation, low operative mortality, and promising long-term, arrhythmia-free survival.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Recurrent ventricular tachyarrhythmias (VT) pose a significant challenge, particularly in ischemic heart disease.
  • Ischemic VT often originates from scarred ventricular endocardium, necessitating targeted ablation strategies.

Purpose of the Study:

  • To evaluate the efficacy and safety of map-guided extensive endocardial resection (EER) for treating recurrent VT in patients with ischemic heart disease.
  • To assess the long-term outcomes, including arrhythmia recurrence and survival rates, following EER.

Main Methods:

  • Twenty-two patients with recurrent VT underwent elective, map-guided extensive endocardial resection (EER).
  • The procedure involved resection of scarred ventricular endocardium, with cryoablation used selectively. Concomitant procedures like aneurysmectomy and coronary artery bypass grafting were common.

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  • Intraoperative mapping guided the resection in most patients.

    • Main Results:

    • The study reported a low operative mortality rate of 4.5% (1 death).
    • Postoperative electrophysiological studies showed no inducible arrhythmias in survivors.
    • At a mean follow-up of 37.2 months, 94% of long-term survivors (77% of all patients) were free from VT without anti-arrhythmic medication.

    Conclusions:

    • Map-guided extensive endocardial resection (EER) is a highly successful treatment for ablating ventricular tachyarrhythmias in ischemic heart disease.
    • EER is associated with low operative mortality and offers good prospects for long-term, arrhythmia-free survival.
    • The procedure demonstrates significant potential for improving quality of life in patients suffering from refractory VT.