Transannular cryoablation of ventricular tachycardia. Surgical technique and results

Intraoperative mapping and cryoablation of ventricular tachycardia was achieved without ventriculotomy in seven patients, who are a subgroup of the 80 patients undergoing map-directed ablation of ventricular tachycardia over a 9-year period. There were four male and three female patients. Their mean age was 53.6 +/- 24.1 years. Coronary artery disease was present in five patients, and two patients had idiopathic ventricular tachycardia. The mean preoperative ejection fraction was 42.4% +/- 13.6%. The mean number of ventricular tachycardia morphologies was 1.7 (range 1 to 3). Epicardial mapping was obtained intraoperatively in all seven patients and endocardial data in five of seven patients (71.4%). There were no hospital deaths and no early or late spontaneous recurrence of clinical monomorphic ventricular tachycardia. Nonclinical monomorphic ventricular tachycardia was inducible in two patients postoperatively and both were treated with procainamide. Death occurred late after operation in two patients: One death was related to recurrent nonclinical VT at 8 months and one at 3 months was due to carcinoma of the stomach. These results suggest that the transannular approach is feasible in selected cases, especially when computerized mapping systems with endocardial balloon electrode arrays can be used.