[Value of mapping in surgical treatment of ventricular tachycardia]

Surgery may be proposed for patients with a localised aneurysm or akinesia for treatment of monomorphic ventricular tachycardia resistant to antiarrhythmic therapy after myocardial infarction. The multiplicity of tachycardia forms in the same patient, the variability of their mechanism which is not necessarily limited to the subendocardia layers, require mapping to guide the surgeon in the destruction of the anatomical substrates. In a series of 57 ventricular tachycardias recorded in 17 patients with myocardial infarction the authors demonstrated that a system of computerised mapping of the epicardial and endocardial regions optimised the results of this form of surgery. Mapping localised, sometimes at a distance from the scar, classical subendocardial reentry, implicated on occasion the mitral papillary muscle in the mechanism or a tachycardia in cases of inferior or lateral infarction and localised the reentry in the epicardium of the lower layers of the septum. The identification of these "atypical" mechanisms significantly improves the number of patients without inducible arrhythmias after surgery (from 50 to 87% in the authors' experience), without changing the operative mortality. The only really curative approach because of the limitations of catheter ablation, this surgery is a complementary method to implantable defibrillators in the management of post-infarction ventricular tachycardia.