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J Thorac Cardiovasc Surg 1998;116:578-583
© 1998 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

LARGE ENCIRCLING CRYOABLATION WITHOUT MAPPING FOR VENTRICULAR TACHYCARDIA AFTER ANTERIOR MYOCARDIAL INFARCTION: LONG-TERM OUTCOME

Montpellier, France

From the Departments of Cardiovascular Surgery^a and Cardiology,^b Arnaud de Villeneuve Hospital, Montpellier, France.

Received for publication Nov 14, 1997. Revisions requested Feb 6, 1998; revisions received March 26, 1998. Accepted for publication June 16, 1998. Address for reprints: Jean-Marc Frapier, MD, Chirurgie Cardiovasculaire Service du Pr Chaptal, Hopital Arnaud de Villeneuve, 34059 Montpellier Cedex, France.

Objective:Map-guided procedures have been the accepted standard for ventricular tachycardia surgery. However, promising results of visually guided resections without mapping have been reported. The goal of this study was to evaluate the efficacy of large encircling cryoablation without mapping for ventricular tachycardia after anterior myocardial infarction.
Methods: Between 1985 and 1996, this procedure, along with aneurysmectomy, was performed on 38 patients for malignant ventricular tachycardia. The mean interval between the operation and myocardial infarction was 59.2 months; 7 patients (18.4%) were operated on within 1 month of myocardial infarction. The mean patient age was 62.1 ± 7.3 years and the mean left ventricular ejection fraction was 29.0% ± 7.2%.
Results: Hospital mortality was 2.6% (1 patient). The electrical success rate based on postoperative electrophysiologic studies was 94.5%. Overall electrical success rate was 89.1%. Freedom from ventricular tachycardia was 77% (95% CI 61%-94%) at both 5 and 7 years. Freedom from sudden cardiac death was 91% (95% CI 80%-100%) at both 5 and 7 years, with overall actuarial survivals at 5 and 7 years of 63% (95% CI 47%-80%) and 42% (95% CI 22%-63%), respectively. The main cause of late death was congestive heart failure in 62.6% of these patients.
Conclusions: One can achieve good results without intraoperative mapping in the treatment of patients with ventricular tachycardia after anterior myocardial infarction by using large encircling cryoablation.

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