Related Experiment Videos
Surgical alternatives in the treatment of life-threatening ventricular arrhythmias
1Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Federal Republic of Germany.
Insights
Electrophysiologically guided surgery effectively treats ischemic ventricular tachycardia. For other cases, automatic implantable cardioverter defibrillators (AICDs) offer palliative care, while heart transplantation suits young patients with progressive disease.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Life-threatening ventricular tachycardia (VT) poses significant management challenges.
- Treatment options for VT include surgery, implantable devices, and transplantation.
- Patient selection is crucial for optimizing outcomes in VT management.
Purpose of the Study:
- To evaluate the efficacy and outcomes of three distinct treatment modalities for life-threatening ventricular tachycardia.
- To compare the results of electrophysiologically guided surgery, automatic implantable cardioverter defibrillators (AICDs), and orthotopic heart transplantation.
- To provide guidance on selecting the most appropriate treatment strategy based on patient characteristics and disease etiology.
Main Methods:
- Retrospective analysis of 97 patients undergoing electrophysiologically guided surgery.
- Review of 42 patients treated with AICD implantation.
- Evaluation of 15 patients who received orthotopic heart transplantation.
- Categorization of patients based on underlying heart disease: ischemic (83%) and non-ischemic (17%).
Main Results:
- Electrophysiologically guided surgery showed 10% early mortality and 5% recurrence in ischemic VT, versus 45% recurrence in non-ischemic VT.
- AICD therapy demonstrated 83% +/- 6.4% 1-year survival, proving effective in all patients, with 5% early and 19% late mortality.
- Heart transplantation achieved a 3-20 month survival in 13 of 15 patients, with mean ejection fraction improving post-transplant.
Conclusions:
- Electrophysiologically guided surgery is highly effective for ischemia-related ventricular tachycardia.
- AICDs serve as a palliative option for patients with poor ventricular function or complex VT.
- Heart transplantation should be prioritized for young patients with progressive heart disease, with AICDs potentially bridging to transplant.
Abstract:
We present our experience in the treatment of life-threatening ventricular tachycardia using electrophysiologically guided surgery (97 patients), automatic implantable cardioverter defibrillator (AICD) (42 patients), and orthotopic heart transplantation (15 patients). Eighty-three percent of these patients had ischemic and 17%, nonischemic heart disease. Our results of electrophysiologically directed surgery show an early mortality of 10% and a recurrence of 5% in the ischemic group. In the nonischemic group, the recurrence was 45%. The AICD was implanted in 31 patients with ischemic heart disease, in 5 with ventricular dysplasia, and in 6 with dilative cardiomyopathy, the ejection fractions ranging from 12% to 65%, with a mean of 30%. Early and late mortalities were 5% and 19%, respectively. The AICD was effective in all patients. Survival rate at 1 year was 83% +/- 6.4%. Thirteen of 15 patients have survived heart transplantation for 3-20 months (mean: 11 months). Ejection fractions prior to transplantation ranged from less than 10% to 34% (mean: 16%). We conclude that electrophysiologically guided surgery is highly effective in most cases of ischemia-related ventricular tachycardia. The AICD is considered a palliative alternative in patients with either poor ventricular function, no electrophysiological substrate, or multimorphological tachycardia. Heart transplantation has to be considered especially in young patients in whom progression of the underlying disease can be anticipated. Bridging by AICD is possible when transplantation is not immediately available or recommendable.