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Ann Thorac Surg 1980;30:499-508
© 1980 The Society of Thoracic Surgeons

Articles

The Surgical Treatment of Ventricular Tachycardia

Alden H. Harken, M.D.*, Leonard N. Horowitz, M.D., Mark E. Josephson, M.D.

From the Divisions of Cardiovascular Surgery and Cardiology, University of Pennsylvania Medical School, Philadelphia, PA

* Address reprint requests to Dr. Harken, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104

Recurrent ventricular tachycardia is a well-recognized complication of ischemic heart disease. Coronary bypass operation with or without aneurysmectomy has been disappointing as therapy for these arrhythmias. With the advent of programmed electrical stimulation, it has become possible to distinguish automatic and reentrant ventricular tachyarrhythmias. The latter have recently proved amenable to operative intervention.

This review examines the pathophysiology and diagnosis of ventricular tachycardia using programmed electrical stimulation. Surgical therapy with resection, revascularization, autonomic modulation, thermal ablation, cardiac pacing, reentrant circuit interruption, and endocardial excision is explored. Operation for cardiac arrhythmias is on a firm electrophysiological foundation. Surgical treatment of refractory ventricular tachyarrhythmias is now rational, recommended, and rewarding.




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