Five cases of arrhythmogenic left ventricular aneurysm unrelated to coronary occlusion

Five among 19 cases of sustained ventricular tachycardia (VT) treated in the last two years had left ventricular aneurysms, but the patients denied any previous attack of chest pains that would indicate acute myocardial infarction. Laboratory findings including serum electrolytes were normal and no signs of inflammation were found. Coronary angiograms were normal but the left ventriculograms showed aneurysms in four patients and akinetic to aneurysmal wall motion in one patient. Electrophysiologic studies (EPS) were done in four patients. VT was induced reproducibly by programmed electrical stimulation in three patients and it was terminated by programmed stimulation within 30 seconds. The foci of VT were determined by EPS. One case who showed acceleration of the VT rate following the second induction of VT developed a fulminant course; Adams-Stokes attacks from VT, more than ten times a night in spite of intravenous administration of a large dose of procainamide, were terminated by DC shock. VT was determined to originate from the aneurysm that was resected operatively. In the other two cases, the foci were resected and the intraoperative EPS confirmed the preoperative foci. The postoperative EPS showed no inducibility of VT in three surgical cases. Though the induction of VT may not be indicated in every case of VT, we believe that EPS is required to determine the focus for the operation and to evaluate the precise drug efficacy in rapid VT. It is further stressed that the sustained VT of our patients including the present five, lasted for several hours until it was terminated in the hospital.