Ventricular tachycardia in post-myocardial infarction patients. Preoperative and intraoperative mapping

Ventricular tachycardia has become a relatively common complication of myocardial infarction and often is an important therapeutic problem, as it is recurrent and life-threatening. Here we report a group of 36 patients with ventricular tachycardia occurring 13 days to 30 years after a myocardial infarction. All patients were resistant to medical treatment and 34 of the 36 patients had had at least one cardiac arrest. All were candidates for surgery for their arrhythmia. The study protocol included prolonged ECG monitoring, a preoperative electrophysiological study with catheter mapping and intraoperative epicardial and endocardial mapping. A total of 52 different tachycardias were mapped in 36 patients. The procedure was facilitated by an automatic mapping device, that allowed the acquisition of 35 simultaneous signals, so that even pleomorphic ventricular tachycardias could be mapped. The information obtained from both preoperative and intraoperative maps guided surgery and restricted the extent of the surgical damage.