Recurrent ventricular tachycardia: how effective is surgical management?

Previous "blind" surgical intervention for recurrent, sustained ventricular tachycardia has been disappointing. Successful surgical intervention requires that a local arrhythmia circuit be interrupted, ablated, or disengaged from the adjacent healthy myocardium while incurring minimal injury to the remaining functional heart. Evidence is accumulating in both animals and human beings that myocardial ischemic damage may yield all the requisite substrates for a sustained reentrant ventricular arrhythmia. Ninety consecutive patients with recurrent, sustained ventricular tachycardia which was refractory to medical therapy underwent electrophysiologically directed surgical therapy. There were eight operative deaths (9 percent surgical mortality within 30 days after operation). In 65 of the 80 patients who underwent postoperative electrophysiologic studies, programmed ventricular stimulation was unable to replicate the clinical arrhythmia. Eight of the 17 patients with postoperatively inducible tachycardia were successfully treated with drugs.