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Surgical management of ventricular tachycardia
S J Shumway1, E M Johnson, C A Svendsen
1Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis 55455, USA. shumw001@maroon.tc.umn.edu
Insights
Focal cryoablation guided by epicardial mapping offers a safe and effective treatment for refractory ventricular tachycardia (VT) when medical management fails, providing a definitive therapy option.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Interventional Cardiology
Background:
- Ventricular tachyarrhythmias (VT) are a major cause of death in coronary artery disease.
- A subset of VT originates from chronically ischemic myocardium and is resistant to medical treatment.
- Epicardial mapping and focal cryoablation can target these refractory VT origins.
Purpose of the Study:
- To evaluate the safety and efficacy of open epicardial mapping and focal cryoablation for patients with refractory ventricular tachycardia.
- To assess the long-term outcomes of this interventional approach in a series of consecutive patients.
Main Methods:
- Retrospective review of 42 patients with malignant VT undergoing surgical treatment.
- Epicardial mapping to identify early electrical activation foci.
- Focal cryoablation using liquid nitrogen-cooled probes, followed by electrophysiologic testing.
Main Results:
- 81% of patients were male, with an average age of 62.9 years and ejection fraction of 0.20.
- An average of 2.1 foci were ablated per patient.
- 30-day operative mortality was 9.5%; 94.7% of survivors were free of VT post-procedure.
Conclusions:
- Open focal cryoablation guided by epicardial mapping is a safe and effective treatment for refractory VT.
- This technique may represent the most definitive therapeutic option for malignant VT.
- Successful cryoablation significantly reduces VT recurrence in patients refractory to medical therapy.
Background:
Ventricular tachyarrhythmias are the leading cause of death from coronary artery disease. A small percentage of these arrhythmias originate in chronically ischemic myocardium, rather than acutely ischemic myocardium, and can be refractory to medical management. Epicardial mapping and focal cryoablation of foci demonstrating early activation may provide definitive therapy when pharmacologic management fails. We report a series of 42 consecutive patients with refractory ventricular tachycardia (VT) who were treated with open epicardial mapping and focal cryoablation after pharmacologic management failed.
Methods:
We retrospectively reviewed the records of patients who underwent surgical treatment of malignant VT. For patients not recently seen in the clinic, we conducted telephone interviews. At the time of operation, epicardial mapping was performed to locate foci of early electrical activation. These foci were then cryoablated, using 2-minute applications of liquid nitrogen-cooled probes. All patients underwent postoperative electrophysiologic studies to test for inducible VT.
Results:
Of these 42 patients, 34 (81%) were male, 8 (19%) female. Average age was 62.9 +/- 10.6 years; ejection fraction, 0.20 (range, 0.04 to 0.50); and number of foci ablated, 2.1 +/- 1.1 (range, 1 to 6). At the time of cryoablation, all patients underwent additional procedures, including aneurysmectomy, coronary artery bypass, or valve replacement. The 30-day operative mortality was 9.5% (4 of 42). Of the 38 survivors, 36 (94.7%) were clinically free of VT; the remaining 2 had spontaneous or inducible VT.
Conclusions:
Open cryoablation of foci propagating VT appears to be safe and effective. It may be the most definitive treatment for malignant VT.