Surgery for ventricular tachycardia: Efficacy of left ventricular aneurysm resection compared with operation guided by electrical activation mapping

Abstract

Sixty-five patients underwent surgery for recurrent ventricular tachyarhythmias. The 32 patients in group 1 underwent simple left ventricular aneurysm resection. The 33 patients in group 2 underwent myocardial resection or incision guided by intraoperative mapping of the electrical activation sequence. The clinical, hemodynamic and angiographic characteristics of the two groups were similar. Although actuarial 13% (±SEM) alive by life-table analysis at 94 months. Arrhythmia recurrence has been greater in group 1 than in group 2. In group 1, 50 ± 9% at 1 month and 56 ± 9% of patients at risk at 3 months had recurrences by actuarial analysis. In group 2, only 13 ± 6% at 1 month, 17 ± 7% at 3 months and 29 ± 9% at 24 months relapsed. Death was caused by ventricular tachyarrhythmias in 12 of the 17 patients (71%) who died in group 1, but only three of 12 (25%) who died in group 2. We conclude that surgery of the left ventricle, guided and modified by intraoperative mapping of the electrical activation sequence, frequently eliminates ventricular tachyarrhythmias and may be more effective than blind resection of left ventricular aneurysm.