Direct surgical therapy of ventricular arrhythmias in coronary heart disease

The aim of surgical therapy for ventricular arrhythmias is to eliminate the areas of diseases myocardium from which ventricular tachycardias originate. According to the results of endocardial mapping a 2 to 3 mm deep endocardial incision is performed around the identified arrhythmogenic area. Within the past 12 months, 19 patients with coronary heart disease and complex ventricular arrhythmias were operated upon. In 16 cases an endocardial incision was performed. In 5 a left ventricular aneurysm was resected as well, 4 patients received one to 4 coronary vein grafts, and in 7 patients aneurysmectomy and bypass grafting were combined. Except for one relapse, no ventricular tachycardia has reappeared since the operation. Ventricular tachycardia could not be initiated by intracardiac stimulation postoperatively in any of the cases restudied. Four patients died from causes unrelated to ventricular arrhythmias. Direct surgical therapy was proven a promising new approach in patients with ventricular tachycardia or complex ventricular arrhythmia refractory to medical treatment. Our technique of endocardial incision appears to be effective and less traumatic to the myocardium than the original transmural encircling incision.