Surgery for ventricular tachycardia originating from the left ventricular summit
Takashi Nitta1, Shun-Ichiro Sakamoto1, Hiroshige Murata2
1Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Summary
Map-guided surgery using transmural cryothermia effectively treats refractory left ventricular summit ventricular tachycardia (VT). This approach offers a high success rate for patients with incessant VT, even after multiple failed ablations.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Left ventricular summit ventricular tachycardia (VT) is often resistant to standard treatments like medication and catheter ablation.
- Previous interventions such as endocardial and epicardial catheter ablation frequently fail for this specific VT type.
Purpose of the Study:
- To evaluate the efficacy and safety of map-guided surgery for left ventricular summit VT.
- To assess the long-term outcomes of patients undergoing this novel surgical approach.
Main Methods:
- Eleven patients with drug-refractory left ventricular summit VT underwent map-guided surgery.
- Intraoperative epicardial mapping identified the VT origin, followed by epicardium-to-endocardium transmural cryothermia.
- Harmonic scalpel was used for epicardial fat removal, and cryothermia was applied to the myocardium, carefully avoiding coronary vessels. Endocardial cryothermia was also performed via aortotomy.
Main Results:
- No surgical or long-term VT-related mortality was observed during a median 60-month follow-up.
- Five-year freedom from documented left ventricular summit VT was 91%, and freedom from non-documented VT was 73%.
- Patients experiencing postoperative VT required successful catheter ablation, while others remained VT-free.
Conclusions:
- Intraoperative electro-anatomical mapping combined with epicardial-to-endocardial transmural cryothermia is crucial for successful surgical treatment of left ventricular summit VT.
- Close collaboration between cardiac surgeons and electrophysiologists is vital for optimal patient outcomes.
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