[Heart transplantation in therapy-resistant, recurrent ventricular tachycardias and ventricular fibrillation]

In life-threatening, drug resistant ventricular tachycardia (VT) or ventricular fibrillation (VF), orthotopic heart transplantation should be considered as an alternative to a directed surgical approach or to the implantation of an automatic defibrillator. We report on nine patients with primary VT or VF who underwent transplantation. These comprised eight men and one woman with a mean age of 35 years (range, 19-51 years); dilative cardiomyopathy was present in seven and coronary artery disease in two. Left ventricular ejection fraction was 19% (11-26%), arrhythmia was recurrent VF in five cases, recurrent VT in two, and recurrent VT/VF in two. Two patients died, one due to acute rejection, and the other 8 months postoperatively due to chronic rejection. The seven other patients are all asymptomatic and leading normal lives without arrhythmias or antiarrhythmic drug therapy. Based on our preliminary experience, some advantages and disadvantages of heart transplantation are discussed in comparison with other treatment modalities. Despite limited indications for orthotopic heart transplantation we feel that it should become the therapy of first choice in young patients with progressive, surgically incorrectable cardiac disease complicated by drug resistant VT or VF.