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Ann Thorac Surg 1975;20:117-126
© 1975 The Society of Thoracic Surgeons

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Articles

Surgical Treatment of Ventricular Arrhythmias Using Epicardial, Transmural, and Endocardial Mapping

From the Department of Surgery, UCLA Medical Center, the Division of Cardiology, Rancho Los Amigos Hospital, University of Southern California, Los Angeles, Calif., and the Department of Pharmacology, Oxford University, Oxford, England.

^* Address reprint requests to Dr. Wittig, Department of Pharmacology, Oxford University, South Parks Rd., Oxford, England OX1 3QT.

In 3 patients with ischemic coronary disease or primary myocardiopathy who were unresponsive to conventional and experimental antiarrhythmia therapy, surgical treatment of intractable ventricular tachycardia was performed using epicardial, transmural, and endocardial mapping techniques. An experimental canine model of acute and chronic myocardial ischemia with recurrent ventricular tachycardia was developed to refine the mapping technique for clinical use.

In patients and animals alike, atrial overdrive pause pacing, premature ventricular pacing, or both were used to bring out a repeatable pattern of tachycardia. Mapping techniques distinguished the irritable focus so that surgical excision of the site of earliest activation could be performed. In addition, the mapping techniques were used in the validation following excision.

The limitations of epicardial mapping alone in locating all areas of premature focus are discussed, and the need for mapping in ventricular aneurysm is demonstrated.

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