Medical versus surgical treatment of tachydysrhythmias

Traditionally, surgical therapy for tachydysrhythmias has been reserved for drug-refractory cases. Accordingly, there has been no study comparing medical with surgical therapy in similar groups of patients. Recent developments in surgical therapy for supraventricular and ventricular tachydysrhythmias have resulted in lower morbidity and mortality with good surgical success. In most patients with the Wolff-Parkinson-White syndrome, accessory pathway division can be performed with very low mortality and high chance for success, obviating the need for lifelong drug therapy. Similarly, in patients with life-threatening ventricular tachydysrhythmias, several operative techniques including the encircling endocardial ventriculotomy and subendocardial resection offer an alternative to therapy which often requires frequent dosing with one or more medications, each associated with a significant incidence of adverse effects. These newer operative techniques for both supraventricular and ventricular tachydysrhythmias are challenging the widely held concept that surgery should be reserved only for patients with drug-refractory tachydysrhythmias.