HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article 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 Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ostermeyer, J. Articles by Blackstone, E. H. Search for Related Content PubMed PubMed Citation Articles by Ostermeyer, J. Articles by Blackstone, E. H.

The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 848-865, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Direct operations for the management of life-threatening ischemic ventricular tachycardia

J Ostermeyer, M Borggrefe, G Breithardt, A Podczek, A Goldmann, JD Schoenen, R Kolvenbach, E Godehardt, JW Kirklin and EH Blackstone
Chirurgische Universitatsklinik B, Dusseldorf, Federal Republic of Germany.

Between June 1978 and 1986, 93 consecutive patients underwent electrophysiologically guided operations for life-threatening recurrent sustained ventricular tachycardia mostly associated with other surgical procedures, such as left ventricular resection (aneurysmectomy) and coronary artery bypass grafting. Data: Eighty-seven percent of the surviving patients were free of spontaneous ventricular tachycardia return or sudden death 1 year after the operation and 77% at 5 years. The instantaneous risk of ventricular tachycardia return was highest immediately after operation, declined rapidly, and by 2 weeks postoperatively had merged with the constant hazard phase, which persisted as long as the patients were observed. Endocardial resection, rather than encircling endocardial myotomy, increased the risk of spontaneous ventricular tachycardia return/sudden death. Survival rates, including hospital deaths, were 95% at 30 days, 89% at 1 year, and 70% at 5 years after operation. The most prevalent mode of death was heart failure. The absence of anterolateral left ventricular aneurysms and the use of more extended encircling incisional techniques for ventricular tachycardia ablation increased the risk of early and late death. Survival was particularly poor in that subset of patients in whom recurrent sustained ventricular tachycardia returned after operation; the most prevalent mode of death in this group was also progressive left ventricular failure. Inferences: (1) Complete and partial encircling endocardial myotomy incisions are the most effective surgical techniques for malignant ventricular tachycardia ablation. (2) Because of their adverse effects on left ventricular structure and function, the arrhythmogenic tissues have to be localized as precisely as possible, and the encompassing incisions should be kept as limited as possible. (3) The late return of ventricular tachycardia may be more related to a progressive ischemic left ventricular cardiomyopathy than to an inadequate operation.

This article has been cited by other articles:

				D. Lindblom, A. Albage, and U. Sartipy Surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration MMCTS, December 17, 2007; 2007(1217): 2816. [Abstract] [Full Text] [PDF]

				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]

				J. Raman, A. Dixit, M. Storer, D. Hare, and B. F. Buxton Geometric endo-ventricular patch repair of inferior left ventricular scars improves mitral regurgitation and clinical outcome Ann. Thorac. Surg., September 1, 2001; 72(3): S1055 - 1058. [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]

				D. Pfeiffer, R. Moosdorf, R. H. Svenson, L. Littmann, W. Grimm, P. G. Kirchhoff, and B. Luderitz Epicardial Neodymium: YAG Laser Photocoagulation of Ventricular Tachycardia Without Ventriculotomy in Patients After Myocardial Infarction Circulation, December 15, 1996; 94(12): 3221 - 3225. [Abstract] [Full Text]

				Y. Kawamura, P. L. Page, R. Cardinal, P. Savard, and R. Nadeau MAPPING OF SEPTAL VENTRICULAR TACHYCARDIA: CLINICAL AND EXPERIMENTAL CORRELATIONS J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 914 - 925. [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]