Surgical Endoepicardial Linear Ablation for Ventricular Tachycardia With Postinfarction Left Ventricular Aneurysm
Changcheng Liu1, Zhaoping Su1, Liangshan Wang1
1Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China.
Insights
Surgical endoepicardial linear ablation is a feasible treatment for ventricular tachycardia in patients with postinfarction left ventricular aneurysm. This approach, combined with coronary artery bypass grafting and aneurysm repair, showed manageable recurrence and mortality rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postinfarction left ventricular aneurysm is associated with increased risk of ventricular tachycardia.
- Surgical interventions for ventricular tachycardia in this population are challenging.
- Off-pump coronary artery bypass grafting and left ventricular aneurysm repair are established procedures.
Purpose of the Study:
- To evaluate the feasibility and outcomes of surgical endoepicardial linear ablation for ventricular tachycardia in patients with postinfarction left ventricular aneurysm.
- To compare safety and clinical outcomes between patients who underwent ablation and those who did not.
- To identify risk factors for mortality in this patient cohort.
Main Methods:
- Retrospective study of 64 patients with multivessel coronary artery disease and left ventricular aneurysm.
- All patients underwent off-pump coronary artery bypass grafting and linear plication for aneurysm repair.
- Twenty-three patients underwent surgical endoepicardial linear ablation guided by epicardial substrate mapping; 41 did not.
Main Results:
- Ventricular tachycardia recurrence rate was 17.4% (immediate) and 23.8% (late follow-up) in the ablation group.
- Early mortality rates were 8.7% (ablation) vs. 4.9% (no ablation); late mortality rates were 19.1% vs. 18%.
- Poor preoperative left ventricular function was an independent risk factor for mortality; cumulative survival rates were similar between groups.
Conclusions:
- Surgical endoepicardial linear ablation is a feasible treatment for carefully selected patients with ventricular tachycardia and postinfarction left ventricular aneurysm.
- The procedure can be safely combined with off-pump coronary artery bypass grafting and left ventricular aneurysm linear plication.
- Outcomes are manageable, with recurrence and mortality rates comparable to non-ablation groups, emphasizing careful patient selection.
Abstract:
This retrospective study evaluated the feasibility of surgical endoepicardial linear ablation for ventricular tachycardia in patients with postinfarction left ventricular aneurysm. Sixty-four patients with multivessel coronary artery disease and left ventricular aneurysm but no mural thrombosis of the aneurysm or valve disease were treated at our institution from March 2012 through July 2015. All underwent off-pump coronary artery bypass grafting and left ventricular aneurysm repair by linear plication. Twenty-three patients (35.9%) had ventricular tachycardia and underwent surgical endoepicardial linear ablation on the beating heart guided by epicardial substrate mapping with the Carto 3 system. The remaining 41 patients (64.1%) composed the no-ablation group. The effectiveness of surgical linear ablation in the ablation group was evaluated. Safety and clinical outcomes were evaluated and compared between the groups. The ventricular tachycardia recurrence rate in the ablation group was 17.4% in the immediate postoperative period and 23.8% at last follow-up (39 ± 21 mo). Early (<30-d) mortality rates were 8.7% in the ablation group and 4.9% in the no-ablation group (P=0.41); the respective late mortality rates were 19.1% and 18% (P=0.70). Multivariate Cox regression analysis indicated that preoperatively poor left ventricular function was an independent risk factor for early and late death in both groups. The groups were similar in terms of the need for postoperative mechanical circulatory support, intensive care unit stay, and cumulative survival rate. We conclude that, for carefully selected candidates, surgical endoepicardial linear ablation combined with off-pump coronary artery bypass grafting and left ventricular aneurysm linear plication is a feasible treatment for ventricular tachycardia with postinfarction left ventricular aneurysm.
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