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 Krafchek, J. Articles by Wyndham, C. R. Search for Related Content PubMed PubMed Citation Articles by Krafchek, J. Articles by Wyndham, C. R.

Circulation, Vol 73, 1239-1247, Copyright © 1986 by American Heart Association

ARTICLES

Surgical ablation of ventricular tachycardia: improved results with a map-directed regional approach

J Krafchek, GM Lawrie, R Roberts, SA Magro and CR Wyndham

To determine whether a regional approach to surgery for ventricular tachycardia would improve on the results of previously reported methods of endocardial resection, an analysis was performed of our surgical experience over a 5 year period. Of 46 consecutive patients operated on for recurrent sustained ventricular tachycardia or ventricular fibrillation, 39 patients with ischemic heart disease underwent subendocardial resection and/or cryoablation. The mean age of the patients was 61 +/- 8 (SD) years, the mean left ventricular ejection fraction was 32 +/- 11%, and the mean number of ineffective antiarrhythmic drugs was 3.8 +/- 1.2 per patient. In 35 of 39 patients in whom mapping data were obtainable, 56 (86%) tachycardias had earliest sites of activation in the left ventricle and nine (14%) had earliest sites in the right ventricle. Ten patients had 14 tachycardias (21%) mapped to areas outside visible dense scar. Of these 35 patients, 10 underwent localized subendocardial resection and 25 underwent a regional procedure in which all areas activated before the surface QRS during ventricular tachycardia were excised and/or cryoablated. In the operative survivors of electrophysiologically guided surgery, three of eight (38%) patients with the localized and one of 24 (4%) patients who underwent the regional procedure had recurrence of ventricular tachycardia during a follow-up period of 1 to 59 (mean 22 +/- 17) months (p = .04). The favorable outcome of regional surgery was not influenced by the presence of multiple morphologies in 54%, disparate sites of origin in 29%, or inferior wall foci in 46% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				L. L. Mickleborough Surgical Treatment of Ventricular Arrhythmias Card. Surg. Adult, January 1, 2003; 2(2003): 1287 - 1292. [Full Text]

				U. O. von Oppell, D. Milne, A. Okreglicki, and R. N. Scott Millar Surgery for ventricular tachycardia of left ventricular origin: risk factors for success and long-term outcome Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 762 - 770. [Abstract] [Full Text] [PDF]

				F. Wellens, P. Geelen, E. Demirsoy, F. Van Praet, R. De Geest, I. Degrieck, H. Vanermen, and P. Brugada Surgical treatment of tachyarrhythmias due to postinfarction left ventricular aneurysm with endoaneurysmorrhaphy and cryoablation Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 771 - 776. [Abstract] [Full Text] [PDF]

				H. Calkins, A. Epstein, D. Packer, A. M. Arria, J. Hummel, D. M. Gilligan, J. Trusso, M. Carlson, R. Luceri, H. Kopelman, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: Results of a prospective multicenter study J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1905 - 1914. [Abstract] [Full Text] [PDF]

				B. J. Deal, J. P. Jacobs, and C. Mavroudis Congenital Heart Surgery Nomenclature and Database Project: arrhythmias Ann. Thorac. Surg., April 1, 2000; 69(4): S319 - 331. [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. 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]

				W. G. Stevenson, P. L. Friedman, and M. O. Sweeney Catheter Ablation as an Adjunct to ICD Therapy Circulation, September 2, 1997; 96(5): 1378 - 1380. [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]