SURGICAL-TREATMENT OF VENTRICULAR TACHYCARDIAS - COMPLETE VERSUS PARTIAL ENCIRCLING ENDOCARDIAL VENTRICULOTOMY

  • 1 January 1984
    • journal article
    • research article
    • Vol. 87  (4) , 517-525
Abstract
Consecutive patients (40) underwent electrophysiologically guided encircling endocardial ventriculotomy as treatment for recurrent sustained ventricular tachycardia resulting from coronary artery disease and previous myocardial infarction. Twelve patients (30%, group I) had a complete encircling endocardial ventriculotomy and 28 (70%, group II) had a partial encircling endocardial ventriculotomy (54.4% .+-. 2.2% of the left ventricular endocardial circumference) at the earliest electrical activation during ventricular tachycardia. There were no significant differences between the 2 groups in age, sex ratio, New York Heart Association class, coronary disease, aneurysm location, concomitant bypass grafting and left ventricular function. One patient of group I and 2 patients of group II did not survive the perioperative period (8 vs. 7%, not significant). The survivors were restudied electrophysiologically about 3 wk after the operation. Eight patients of group I and 19 patients of group II were free of ventricular tachycardia (no spontaneous or inducible ventricular tachycardia) without antiarrhythmic drugs (73 vs. 73%, not significant). The mean follow-up period in group I is 22.6 mo. and in group II, 15.2 mo. Five patients of group I and of group II developed severe left ventricular dysfunction (46 vs. 8%; P = 0.025). Also, congestive heart failure was a significant cause of death in group I patients (P = 0.036). In conclusion, electrophysiologically guided partial encircling endocardial ventriculotomy is highly efficient as a surgical treatment of recurrent sustained ventricular tachycardia. Complete encircling endocardial ventriculotomy offers no better ablation of arrhythmias and should be avoided because of its apparent hazards to left ventricular performance.