The Annals of Thoracic Surgery, Vol 42, 13-16, Copyright © 1986 by The Society of Thoracic Surgeons
Surgical management of sustained ventricular arrhythmias presenting within eight weeks of acute myocardial infarction
IL Kron, B Lerman and JP DiMarco
When it occurs after a recent (less than eight weeks) myocardial
infarction, sustained ventricular tachycardia (VT) or fibrillation (VF) has
resulted in a high one-year mortality despite antiarrhythmic drug therapy.
We have operated on 29 patients with this syndrome either on an emergency
basis because they had medically refractory VT or VF (19 patients) or
electively if they had persistent congestive heart failure or angina and VT
or VF (10 patients). Ages ranged from 36 to 82 years (mean, 60 years), and
the mean left ventricular ejection fraction was 31 +/- 13%. Each patient
had failed a trial of one or more (average, four) antiarrhythmic drugs and
because of VT, required electrical cardioversion on an average of five
occasions. Intraoperative mapping was complicated by multiple VT
morphologies (9 patients), the rapid degeneration of VT to VF (5 patients),
and the inability to induce VT reliably (5 patients). Subendocardial
excision was performed at the site of the earliest electrical activity, or
if no single site could be identified, a wide subendocardial excision of
all visible scar was performed. There were 4 perioperative deaths (14%).
All operative survivors underwent postoperative electrophysiological
studies. Twenty of them required no further antiarrhythmic therapy, but 5
patients required drug therapy because of either spontaneous (2 patients)
or electrically induced (3 patients) VT. During follow-up (average, 16
months) of these 25 patients, there have been 3 late deaths, 2 of them
sudden. Two of the 3 late deaths were those of patients taking
antiarrhythmic drugs. Our results demonstrate the effectiveness of early
operative intervention when sustained ventricular arrhythmias complicate
recovery after myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)