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Arrhythmogenic ventricular aneurysms unrelated to coronary artery disease
H A Rajasinghe1, H P Lorenz, M T Longaker
1Division of Cardiothoracic Surgery, University of California, San Francisco 94143, USA.
Insights
Malignant ventricular tachycardia with normal coronary arteries and left ventricular aneurysm is rare. Surgical intervention, including aneurysmectomy and electrophysiologic mapping, effectively treated most patients, offering a long-term solution.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Malignant ventricular tachycardia (VT) typically affects patients with coronary artery disease and myocardial infarction.
- VT in the context of normal coronary arteries and a left ventricular aneurysm is uncommon and often resistant to medical treatment.
Purpose of the Study:
- To evaluate the efficacy of surgical treatment for ventricular tachycardia in patients with normal coronary arteries and left ventricular aneurysm.
Main Methods:
- Retrospective review of 10 patients treated between 1983 and 1993.
- All patients underwent electrophysiologic testing and cardiac catheterization (9/10).
- Diagnosis of left ventricular aneurysm confirmed via imaging modalities or angiography.
Main Results:
- Seven out of ten patients had VT refractory to multiple antiarrhythmic drugs.
- Six patients underwent successful surgical treatment involving electrophysiologic mapping, endocardial resection, and left ventricular aneurysmectomy.
- Two patients received implantable cardioverter-defibrillator devices.
- Postoperative electrophysiologic studies showed no inducible VT in surgically treated patients, who remained off antiarrhythmic therapy during follow-up (mean 56 months).
Conclusions:
- Surgical management, including left ventricular aneurysmectomy guided by electrophysiologic mapping, is a viable and effective treatment for drug-refractory ventricular tachycardia in patients with normal coronary arteries and left ventricular aneurysm.
- This approach can lead to long-term freedom from VT and antiarrhythmic therapy.
Abstract:
Malignant ventricular tachycardia occurs most frequently in patients with coronary artery disease who have had a previous myocardial infarction and in whom a ventricular aneurysm subsequently develops in the scarred section of myocardium. Ventricular tachycardia in the presence of normal coronary arteries and a left ventricular aneurysm is unusual and can be refractory to medical therapy. We retrospectively reviewed our experience of 10 patients treated at our institution from 1983 to 1993. Age ranged from 22 to 76 years, and all patients presented with sustained ventricular tachycardia. All patients underwent complete electrophysiologic testing. Cardiac catheterization was performed in 9 patients, and each had normal coronary artery anatomy without evidence of significant fixed lesions. A left ventricular aneurysm, diagnosed by either echocardiography, thoracic cine computed tomography or magnetic resonance imaging, or ventricular angiography was present in all patients. Ventricular tachycardia could not be suppressed pharmacologically in 7 of 10 patients using multiple agents including procainamide, quinidine, flecanide, tocainide, propaferone, and amiodarone. Six patients were treated surgically by intraoperative electrophysiologic mapping, endocardial resection of foci, and left ventricular aneurysmectomy. An implantable cardiac defibrillation device was implanted in 2 patients. One patient died on the second postoperative day after simultaneous mapping -guided aneurysmectomy and implantable cardioverter defibrillator placement. There was one late postoperative death. All other surgically treated patients had postoperative electrophysiologic studies demonstrating no inducible ventricular tachycardia, and these patients remain without antiarrhythmic therapy in follow-up extending from 29 to 86 months (mean, 56 months).(ABSTRACT TRUNCATED AT 250 WORDS)