Surgical alternatives in the treatment of life-threatening ventricular arrhythmias

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Abstract
We present our experience in the treatment of life-threateningventricular tachycardia using electrophysiologically guided surgery (97patients), automatic implantable cardioverter defibrillator (AICD) (42patients), and orthotopic heart transplantation (15 patients). Eighty-three percent of these patients had ischemic and 17%, nonischemic heartdisease. Our results of electrophysiologically directed surgery show anearly mortality of 10% and a recurrence of 5% in the ischemic group. In thenonischemic group, the recurrence was 45%. The AICD was implanted in 31patients with ischemic heart disease, in 5 with ventricular dysplasia, andin 6 with dilative cardiomyopathy, the ejection fractions ranging from 12%to 65%, with a mean of 30%. Early and late mortalities were 5% and 19%,respectively. The AICD was effective in all patients. Survival rate at 1year was 83% +/- 6.4%. Thirteen of 15 patients have survived hearttransplantation for 3-20 months (mean: 11 months). Ejection fractions priorto transplantation ranged from less than 10% to 34% (mean: 16%). Weconclude that electrophysiologically guided surgery is highly effective inmost cases of ischemia-related ventricular tachycardia. The AICD isconsidered a palliative alternative in patients with either poorventricular function, no electrophysiological substrate, ormultimorphological tachycardia. Heart transplantation has to be consideredespecially in young patients in whom progression of the underlying diseasecan be anticipated. Bridging by AICD is possible when transplantation isnot immediately available or recommendable.

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