Nonischemic ventricular tachycardia: surgical or medical treatment?

Fifty-two consecutive patients with nonischemic ventricular tachycardia (VT) were seen between 1985 and 1991. Twenty-two patients underwent surgery, while in the remaining 30, the VT was well controlled on medication. In the surgical group, arrhythmogenic right ventricular dysplasia (ARVD) was the cause of VT in 12 patients, cardiomyopathy (CM) in 6, posttetralogy of Fallot repair in 2, myocarditis in 1, and myocardial hamartoma in 1. The mean number of drugs tried and found ineffective was 5.5. There were three early deaths; 13 patients are symptom-free without taking any medication. In the medical group, the pathology associated with the VT was myocarditis in 2 patients, CM in 11, and ARVD in 2. In ten patients, VT appeared idiopathic, 1 was exercise-induced, 3 were catecholamine sensitive, and 1 presented with long QT syndrome. Beta blockers controlled the symptoms in 43% of the patients, amiodarone in 20%, and flecainide in 17%. The mortality was higher in the surgical group, but 95% of them are VT-free, compared with those on medical treatment (55%) over the last 8 years' follow-up. In conclusion, the nonischemic VT is a serious condition. Medical therapy is usually effective, but if it fails, VT surgery should be considered.