The status of surgery for cardiac arrhythmias

Successful surgical treatment of all forms of supraventricular tachyarrhythmias is dependent on accurate electrophysiologic guidance. Surgery for WPW syndrome is no longer experimental and should be offered to (1) patients with medically refractory reciprocating tachycardia associated with the syndrome, (2) patients with spontaneous atrial fibrillation who are at risk for sudden death, (3) patients with drug intolerance, and (4) young, otherwise healthy patients with symptoms that warrant more than minimal medical therapy. The current results of surgery for WPW syndrome would seem to lessen the likelihood that a major new method of superior nonpharmacologic treatment will emerge in the near future. Surgery for most other types of supraventricular tachyarrhythmias remains experimental and should be applied only under the most controlled circumstances and after satisfying the most rigid criteria for surgical intervention, the main indication being absolute medical refractoriness. The single exception at the present time is surgery for AV node reentry tachycardia, which appears to be easily cured by the new technique of discrete cryosurgery of the peri-AV nodal region of the lower right atrial septum. In a majority of patients, ventricular tachycardia can be successfully ablated surgically without the use of electrophysiologic mapping to guide the surgeon. If such an approach is taken, however, the surgical treatment of these complex arrhythmias becomes a completely service-oriented exercise. Although delivery of such a service is of undeniable importance, the potential for learning more about these complex and lethal arrhythmias is lost unless each patient is studied as comprehensively as possible.(ABSTRACT TRUNCATED AT 250 WORDS)