This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Miller, J. M. Articles by Josephson, M. E. Search for Related Content PubMed PubMed Citation Articles by Miller, J. M. Articles by Josephson, M. E.

Circulation, Vol 70, 624-631, Copyright © 1984 by American Heart Association

ARTICLES

Subendocardial resection for ventricular tachycardia: predictors of surgical success

JM Miller, MG Kienzle, AH Harken and ME Josephson

We retrospectively evaluated the first 100 patients who underwent mapping-guided subendocardial resection (SER) at our hospital for drug- refractory sustained ventricular tachycardia caused by coronary artery disease. There were 91 survivors of surgery with 200 morphologically distinct types of ventricular tachycardia. Eighty-three patients (91%) were cured of ventricular tachycardia by SER alone (60 patients or 66%) or by SER in combination with antiarrhythmic drug therapy (23 patients or 25%) (mean follow-up, 28 +/- 19 months). There were four late sudden deaths and four patients continued to have rare episodes of spontaneous ventricular tachycardia after surgery despite receiving antiarrhythmic drugs. Factors associated with failure of SER alone to cure ventricular tachycardia were presence of disparate sites of ventricular tachycardia origin (greater than 5 cm between mapped sites of origin; 64% vs 30% failure rate) and presence of multiple morphologically distinct spontaneous tachycardias (47% vs 25% failure rate). A log-linear model of multivariate analysis identified disparate sites of origin of ventricular tachycardia and the absence of a discrete left ventricular aneurysm as the only independent variables associated with failure of surgery alone. Inferior wall site of origin (41% vs 12% failure) and right bundle branch block morphology of ventricular tachycardia (20% vs 7% failure) were also significantly associated with failure of surgery to cure ventricular tachycardia. Mapping-guided SER is a highly effective mode of treatment for drug-refractory ventricular tachycardia, despite the existence of subgroups of patients with higher- than-average surgical failure rates.

This article has been cited by other articles:

				J. Almendral and M. E. Josephson All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator Circulation, September 4, 2007; 116(10): 1204 - 1212. [Full Text] [PDF]

				P. Della Bella, S. Riva, G. Fassini, F. Giraldi, M. Berti, C. Klersy, and N. Trevisi Incidence and significance of pleomorphism in patients with postmyocardial infarction ventricular tachycardia: Acute and long-term outcome of radiofrequency catheter ablation Eur. Heart J., July 1, 2004; 25(13): 1127 - 1138. [Abstract] [Full Text] [PDF]

				V. Y. Reddy, P. Neuzil, M. Taborsky, and J. N. Ruskin Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2228 - 2236. [Abstract] [Full Text] [PDF]

				P. Della Bella and N. Trevisi Catheter ablation: is it good for all postinfarction ventricular tachycardias? Eur. Heart J., November 1, 2002; 23(21): 1645 - 1647. [Full Text] [PDF]

				P. Della Bella, R. De Ponti, J.A.S. Uriarte, C. Tondo, C. Klersy, C. Carbucicchio, C. Storti, S. Riva, and M. Longobardi Catheter ablation and antiarrhythmic drugs for haemodynamically tolerated post-infarction ventricular tachycardia. Long-term outcome in relation to acute electrophysiological findings Eur. Heart J., March 1, 2002; 23(5): 414 - 424. [Abstract] [Full Text] [PDF]

				A. Martinez-Rubio, J. Kuschyk, G. Sierra, G. Breithardt, and M. Borggrefe Programmed ventricular stimulation: influence of early versus late introduction of a third extrastimulus, a randomized, prospective study Europace, January 1, 2002; 4(1): 77 - 85. [Full Text] [PDF]

				H. Calkins, J. T. Bigger Jr, S. J. Ackerman, S. B. Duff, D. Wilber, R. A. Kerr, M. Bar-Din, K. M. Beusterien, and M. J. Strauss Cost-Effectiveness of Catheter Ablation in Patients With Ventricular Tachycardia Circulation, January 25, 2000; 101(3): 280 - 288. [Abstract] [Full Text] [PDF]

				J P Bourke, R W F Campbell, J M McComb, S S Furniss, J C Doig, and C J Hilton Surgery for postinfarction ventricular tachycardia in the pre-implantable cardioverter defibrillator era: early and long term outcomes in 100 consecutive patients Heart, August 1, 1999; 82(2): 156 - 162. [Abstract] [Full Text] [PDF]

				J. P. Bourke, J. Gray, C. J. Hilton, S. S. Furniss, S. Khan, J. M. McComb, and R. W.F. Campbell Identifying patients at low risk of death from cardiac failure after operation for postinfarct ventricular tachycardia Ann. Thorac. Surg., February 1, 1999; 67(2): 404 - 410. [Abstract] [Full Text] [PDF]

				J. M. Frapier, J. J. Hubaut, J. L. Pasquie, and P. A. Chaptal LARGE ENCIRCLING CRYOABLATION WITHOUT MAPPING FOR VENTRICULAR TACHYCARDIA AFTER ANTERIOR MYOCARDIAL INFARCTION: LONG-TERM OUTCOME J. Thorac. Cardiovasc. Surg., October 1, 1998; 116(4): 578 - 583. [Abstract] [Full Text] [PDF]

				W. G. Stevenson, P. L. Friedman, D. Kocovic, P. T. Sager, L. A. Saxon, and B. Pavri Radiofrequency Catheter Ablation of Ventricular Tachycardia After Myocardial Infarction Circulation, July 28, 1998; 98(4): 308 - 314. [Abstract] [Full Text] [PDF]

				S. A. Rothman, H. H. Hsia, S. F. Cossu, I. L. Chmielewski, A. E. Buxton, and J. M. Miller Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia : Long-term Success and the Significance of Inducible Nonclinical Arrhythmias Circulation, November 18, 1997; 96(10): 3499 - 3508. [Abstract] [Full Text]

				H. Rastegar, M. S. Link, C. B. Foote, P. J. Wang, A. S. Manolis, and N.A. M. Estes Perioperative and Long-term Results With Mapping-Guided Subendocardial Resection and Left Ventricular Endoaneurysmorrhaphy Circulation, September 1, 1996; 94(5): 1041 - 1048. [Abstract] [Full Text]

				V. Dor, M. Sabatier, F. Montiglio, P. Rossi, A. Toso, and M. Di Donato Results of nonguided subtotal endocardiectomy associated with left ventricular reconstruction in patients with ischemic ventricular arrhythmias J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1301 - 1308. [Abstract] [Full Text]

				R. Lee, J. D. Mitchell, H. Garan, J. N. Ruskin, B. A. McGovern, M. J. Buckley, D. F. Torchiana, and G. J. Vlahakes Operation for recurrent ventricular tachycardiaPredictors of short- and long-term efficacy J. Thorac. Cardiovasc. Surg., March 1, 1994; 107(3): 732 - 742. [Abstract] [Full Text]