Ten years electrophysiologically guided direct operations for malignant ischemic ventricular tachycardia--results

During the recent 10 years period worldwide more than 1000 patients underwent an electrophysiologically guided direct operation for malignant ventricular tachycardia in the setting of chronic ischemic heart disease. The published results of these operations as regards relief of ventricular tachycardia and survival are highly variable. The data presented here are largely based on a multi-institutional registry series (n = 665) and the combined Düsseldorf-Birmingham/Alabama (DUS-UAB) ventricular tachycardia surgery experience (n = 216).

Survival (hospital deaths included) was 75% one year after operation and 45% at 5 years (DUS-UAB). The respective data of the registry series were 78% and 55%. The most prevalent mode of death in both analyses was acute/subacute/chronic heart failure. More extensive encircling procedures (incisional/cryo) for ventricular tachycardia ablation and the combination of encircling cryoablation and endocardial resection increased the risk of progressive left ventricular dysfunction and death; however, by multivariate analysis the severity of the underlying ischemic heart disease (indicated by NYHA functional class, LVEDP, No. of previous infarcts, and extensiveness of coronary disease) and the absence of a discrete left ventricular aneurysm were more powerful predictors for early and late postoperative mortality than the use of alternative surgical techniques for ventricular tachycardia ablation. Survival was particularly poor after the return of spontaneous sustained ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)