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Subendocardial resection for ventricular tachycardia: predictors of surgical success
Insights
Mapping-guided subendocardial resection (SER) effectively treats drug-refractory ventricular tachycardia in coronary artery disease patients. Most patients achieved a cure, with factors like disparate tachycardia origins impacting success.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Drug-refractory sustained ventricular tachycardia (VT) in coronary artery disease (CAD) poses significant treatment challenges.
- Subendocardial resection (SER) is a surgical option for managing refractory VT.
Purpose of the Study:
- To evaluate the efficacy and outcomes of mapping-guided subendocardial resection (SER) for drug-refractory VT in CAD patients.
- To identify factors associated with surgical success or failure.
Main Methods:
- Retrospective analysis of the first 100 patients undergoing mapping-guided SER for drug-refractory VT due to CAD.
- Follow-up assessment of VT recurrence, survival, and adverse events.
Main Results:
- 91% of patients (83/91 survivors) were cured of VT by SER alone or with antiarrhythmic drugs.
- Factors predicting failure included disparate VT origins (>5 cm apart) and multiple distinct VT morphologies.
- Absence of a discrete left ventricular aneurysm was also linked to surgical failure.
Conclusions:
- Mapping-guided SER is a highly effective treatment for drug-refractory VT in CAD patients.
- Specific patient subgroups, such as those with disparate VT origins or specific aneurysm characteristics, have higher failure rates.
- Further research may refine patient selection for optimal SER outcomes.
Abstract:
We retrospectively evaluated the first 100 patients who underwent mapping-guided subendocardial resection (SER) at our hospital for drug-refractory sustained ventricular tachycardia caused by coronary artery disease. There were 91 survivors of surgery with 200 morphologically distinct types of ventricular tachycardia. Eighty-three patients (91%) were cured of ventricular tachycardia by SER alone (60 patients or 66%) or by SER in combination with antiarrhythmic drug therapy (23 patients or 25%) (mean follow-up, 28 +/- 19 months). There were four late sudden deaths and four patients continued to have rare episodes of spontaneous ventricular tachycardia after surgery despite receiving antiarrhythmic drugs. Factors associated with failure of SER alone to cure ventricular tachycardia were presence of disparate sites of ventricular tachycardia origin (greater than 5 cm between mapped sites of origin; 64% vs 30% failure rate) and presence of multiple morphologically distinct spontaneous tachycardias (47% vs 25% failure rate). A log-linear model of multivariate analysis identified disparate sites of origin of ventricular tachycardia and the absence of a discrete left ventricular aneurysm as the only independent variables associated with failure of surgery alone. Inferior wall site of origin (41% vs 12% failure) and right bundle branch block morphology of ventricular tachycardia (20% vs 7% failure) were also significantly associated with failure of surgery to cure ventricular tachycardia. Mapping-guided SER is a highly effective mode of treatment for drug-refractory ventricular tachycardia, despite the existence of subgroups of patients with higher-than-average surgical failure rates.