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Cryosurgery for ventricular bigeminy using a transaortic closed ventricular approach.

F E Vermeulen1, N M van Hemel, G M Guiraudon

  • 1Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.

European Heart Journal
|September 1, 1988
PubMed
Summary

Surgical ablation effectively treated disabling ventricular bigeminy when drugs failed. A transaortic approach for mapping and cryocoagulation improved outcomes in drug-resistant ventricular arrhythmias.

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Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Disabling monomorphic ventricular bigeminy is not a recognized surgical indication.
  • Drug therapy often fails for severe ventricular arrhythmias.

Observation:

  • Three young patients with drug-resistant ventricular bigeminy, sometimes progressing to ventricular tachyarrhythmias, underwent surgical ablation.
  • Preoperative catheter mapping identified the earliest endocardial origin in both ventricles.

Findings:

  • A transaortic approach with cryocoagulation successfully abolished the arrhythmia in two patients with accurate preoperative mapping.
  • One patient with discordant mapping experienced arrhythmia recurrence and died.
  • Postoperative studies showed minimal myocardial scarring and coronary artery damage in successful cases.

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Implications:

  • The transaortic approach offers a novel surgical option for mapping and ablating ventricular arrhythmias.
  • This technique preserves myocardial function by avoiding left ventriculotomy.
  • Accurate preoperative mapping is crucial for successful surgical outcomes in ventricular arrhythmia ablation.