[An update of surgery for ventricular tachycardia]

The implantable defibrillator has, to a certain degree, taken over some of the indications of antiarrhythmic surgery in ventricular tachycardia resistant to drug therapy. Initially reserved for patient with ventricular aneurysms, this form of surgery may also be proposed for patients with localised infarction. The multiplicity of forms of tachycardia, the variability of their mechanism which is not always limited to the subendocardial layers requires mapping procedure to guide the surgical intervention on the arrhytmogenic substrate. The so-called regional procedures which, for most workers, combine resection and cryo-ablation, is a good compromise between risk and efficacy. This surgery used to be associated with a high mortality but this has been considerably reduced by technical advances in myocardial protection. Similarly, the failure rate has also been reduced by the identification of "atypical" mechanisms. These improvements have been obtained thanks to systems of mapping which allow investigation of the epicardium/endocardium relationship and activation of the deep septal regions. Although the two techniques are not designed for the same type of patient, global mortality of surgically treated patients in the long term is not different to that of patients with an implantable defibrillator. Clinical efficacy of antiarrhythmic surgery is over 90% at 5 years in the majority of large scale trials. This type of surgery is the only really radical approach because of the limitations of catheter ablation and should be considered to be complementary to the implantable defibrillator in the management of post-infarction ventricular tachycardia.