ST segment elevation with ventricular aneurysm: results of encircling endocardial ventriculotomy

The ST segment elevation characteristic of ventricular aneurysm is thought to represent unmodified repolarization of the opposing wall or to arise from viable tissue at the border of the scar because of ischemia, traction or the non-uniform injury that is the architecture for ventricular tachycardia. Encircling endocardial ventriculotomy to prevent tachycardia interrupts coronary perfusion to the viable tissue bordering the scar, with noticeable loss of electrical and mechanical function. Five patients had anterior or apical aneurysms resected and encircled to treat recurrent ventricular tachycardia. ECGs were examined 49 days +/- 12 SEM post-operatively. Encircling did not eliminate their ST segment elevation. Only one patient had less ST elevation post-operatively. Thus ST elevation associated with aneurysms does not arise from viable tissue at the edge of the scar because it persists after this tissue is damaged by encircling endocardial ventriculotomy.