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[Results of electrophysiologically guided surgery in ventricular tachycardia]
Insights
Electrophysiologically guided surgery is an effective treatment for patients with medically refractory ventricular tachycardia (VT) post-myocardial infarction. This approach, utilizing pre- and intraoperative mapping, offers an acceptable alternative for managing complex arrhythmias.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Context:
- Medically refractory ventricular tachycardia (VT) post-myocardial infarction presents a significant clinical challenge.
- Limited effective treatment options exist for patients with persistent VT despite antiarrhythmic drugs.
Purpose:
- To evaluate the efficacy and safety of electrophysiologically guided surgery for medically refractory VT after myocardial infarction.
- To assess the role of pre- and intraoperative mapping in guiding surgical interventions for VT.
Summary:
- Thirty-three patients with refractory VT post-myocardial infarction underwent surgery guided by electrophysiological mapping.
- Preoperative and intraoperative mapping identified VT origins in a majority of patients, guiding surgical techniques like endomyocardial incision or resection.
- Postoperative discharge rate was 82%, with a mean follow-up of 18 months, showing acceptable outcomes despite some mortality and late events.
Impact:
- Surgical therapy guided by electrophysiological mapping is a viable and acceptable alternative for managing refractory VT in coronary artery disease patients.
- This study highlights the importance of precise mapping for successful surgical outcomes in complex ventricular arrhythmias.
Abstract:
We report on 33 patients (pts) with medically refractory ventricular tachycardia (VT) after myocardial infarction in whom electrophysiologically guided surgery was performed. In 18 pts the origin of the VT was identified preoperatively by endocardial catheter mapping. Intraoperative endocardial mapping was performed in 32 pts. The origin of the VT was detected in 24 pts, whereas in 8 pts the surgical procedure was guided by the results of intraoperative mapping during sinus rhythm. In one patient no intraoperative mapping was performed and surgery was guided only according to the results of endocardial catheter mapping. A deep endomyocardial incision was performed in 14 pts, whereas local endocardial resection was done in 19 pts. Six pts (18%) died postoperatively still being in the hospital, 27 pts (82%) were discharged. There were 4 late deaths during mean follow up period of 18 months. One patient had a spontaneous recurrence of VT. 8 pts remained on antiarrhythmic medication due to complex ventricular arrhythmias. We conclude that in case of medically refractory VT in coronary artery disease, surgical therapy becomes an acceptable alternative when guided by pre- and intraoperative electrophysiological mapping.