HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Lynda L. Mickleborough Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mickleborough, L. L. Articles by Gray, G. C. Search for Related Content PubMed PubMed Citation Articles by Mickleborough, L. L. Articles by Gray, G. C.

Ann Thorac Surg 1992;54:832-839
© 1992 The Society of Thoracic Surgeons

---

Articles

Late results of operation for ventricular tachycardia

Division of Cardiovascular Surgery, Department of Surgery, and Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

^_* Address reprint requests to Dr Mickleborough, The Toronto Hospital, EN 13-217, 200 Elizabeth St, Toronto, Ont, Canada M5G 2C4.

We have analyzed results in 54 consecutive patients with recurrent ventricular tachycardia and coronary artery disease in whom we used an aggressive surgical approach involving map-directed ventricular tachycardia ablation, scar excision and left ventricular remodeling, and coronary artery bypass grafting, as well as staged mitral valve replacement when necessary. We have previously shown age greater than 65 years to be an independent predictor of mortality and have excluded such patients from this series. Average age was 56 ±7 years. All patients had a previous myocardial infarction; 24% of the infarctions ([equation]) were posterior in location. Symptoms included syncope or presyncope in 83% of the patients ([equation]), angina in 54% ([equation]), and congestive heart failure in 52% ([equation]). Extensive coronary artery disease was found in 78% ([equation]), and 89% ([equation]) had serious compromise of left ventricular function (ejection fraction <0.40; average ejection fraction, 0.28 ± 0.12). Only 63% ([equation]) appeared to have a resectable left ventricular aneurysm on the preoperative angiogram. Ablation techniques included endocardial excision in 82% ([equation]), with the addition of cryoablation in 60% ([equation]), and balloon electric shock ablation in 22% ([equation]); coronary artery bypass grafting was performed in 85% ([equation]). There were four hospital deaths (7%). The surgical cure rate (no inducible VT at postoperative electrophysiologic study was 72% ([equation]). During follow-up (mean, 50 ± 31 months) there have been six late deaths (1 sudden death, 1 stroke, 4 congestive heart failures with or without mitral regurgitation). Four patients with progressive congestive heart failure and serious mitral regurgitation have undergone repeat operation for mitral valve replacement. All are alive and doing well. Patient follow-up extends to 8 years, and actuarial survival is 79% with 97% freedom from sudden death. We conclude that an aggressive surgical approach in patients with recurrent ventricular tachycardia, extensive coronary artery disease, and poor left ventricular function yields excellent long-term results. During followup, reoperation for mitral valve replacement may be necessary in patients with progressive congestive heart failure associated with mitral regurgitation.

This article has been cited by other articles:

				L. L. Mickleborough, N. Merchant, Y. Provost, S. Carson, and J. Ivanov Ventricular reconstruction for ischemic cardiomyopathy Ann. Thorac. Surg., June 1, 2003; 75(90060): S6 - 12. [Abstract] [Full Text] [PDF]

				L. L. Mickleborough Surgical Treatment of Ventricular Arrhythmias Card. Surg. Adult, January 1, 2003; 2(2003): 1287 - 1292. [Full Text]

				U. O. von Oppell, D. Milne, A. Okreglicki, and R. N. Scott Millar Surgery for ventricular tachycardia of left ventricular origin: risk factors for success and long-term outcome Eur J Cardiothorac Surg, November 1, 2002; 22(5): 762 - 770. [Abstract] [Full Text] [PDF]

				F. Wellens, P. Geelen, E. Demirsoy, F. Van Praet, R. De Geest, I. Degrieck, H. Vanermen, and P. Brugada Surgical treatment of tachyarrhythmias due to postinfarction left ventricular aneurysm with endoaneurysmorrhaphy and cryoablation Eur J Cardiothorac Surg, November 1, 2002; 22(5): 771 - 776. [Abstract] [Full Text] [PDF]

				P. F. A. Bakker, F. de Lange, R. N. W. Hauer, R. Derksen, and J. M. T. de Bakker Sequential map-guided endocardial resection for ventricular tachycardia improves outcome Eur J Cardiothorac Surg, April 1, 2001; 19(4): 448 - 454. [Abstract] [Full Text] [PDF]

				R.J. Schilling, D.W. Davies, and N.S. Peters Clinical developments in cardiac activation mapping Eur. Heart J., May 2, 2000; 21(10): 801 - 807. [PDF]

				L. L. Mickleborough, S. Carson, M. Tamariz, and J. Ivanov RESULTS OF REVASCULARIZATION IN PATIENTS WITH SEVERE LEFT VENTRICULAR DYSFUNCTION J. Thorac. Cardiovasc. Surg., March 1, 2000; 119(3): 550 - 557. [Abstract] [Full Text] [PDF]

				R. J. Schilling, N. S. Peters, and D. W. Davies Feasibility of a Noncontact Catheter for Endocardial Mapping of Human Ventricular Tachycardia Circulation, May 18, 1999; 99(19): 2543 - 2552. [Abstract] [Full Text] [PDF]

				J. P. Bourke, J. Gray, C. J. Hilton, S. S. Furniss, S. Khan, J. M. McComb, and R. W.F. Campbell Identifying patients at low risk of death from cardiac failure after operation for postinfarct ventricular tachycardia Ann. Thorac. Surg., February 1, 1999; 67(2): 404 - 410. [Abstract] [Full Text] [PDF]

				J. M. Frapier, J. J. Hubaut, J. L. Pasquie, and P. A. Chaptal LARGE ENCIRCLING CRYOABLATION WITHOUT MAPPING FOR VENTRICULAR TACHYCARDIA AFTER ANTERIOR MYOCARDIAL INFARCTION: LONG-TERM OUTCOME J. Thorac. Cardiovasc. Surg., October 1, 1998; 116(4): 578 - 583. [Abstract] [Full Text] [PDF]

				R. J. Schilling, N. S. Peters, and D. W. Davies Simultaneous Endocardial Mapping in the Human Left Ventricle Using a Noncontact Catheter : Comparison of Contact and Reconstructed Electrograms During Sinus Rhythm Circulation, September 1, 1998; 98(9): 887 - 898. [Abstract] [Full Text] [PDF]

				H. Rastegar, M. S. Link, C. B. Foote, P. J. Wang, A. S. Manolis, and N.A. M. Estes Perioperative and Long-term Results With Mapping-Guided Subendocardial Resection and Left Ventricular Endoaneurysmorrhaphy Circulation, September 1, 1996; 94(5): 1041 - 1048. [Abstract] [Full Text]

				L. L. Mickleborough, H. Maruyama, Y. Takagi, S. Mohamed, Z. Sun, and L. Ebisuzaki Results of Revascularization in Patients With Severe Left Ventricular Dysfunction Circulation, November 1, 1995; 92(9): 73 - 79. [Abstract] [Full Text]

				V. Dor, M. Sabatier, F. Montiglio, P. Rossi, A. Toso, and M. Di Donato Results of nonguided subtotal endocardiectomy associated with left ventricular reconstruction in patients with ischemic ventricular arrhythmias J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1301 - 1308. [Abstract] [Full Text]

				R. Lee, J. D. Mitchell, H. Garan, J. N. Ruskin, B. A. McGovern, M. J. Buckley, D. F. Torchiana, and G. J. Vlahakes Operation for recurrent ventricular tachycardiaPredictors of short- and long-term efficacy J. Thorac. Cardiovasc. Surg., March 1, 1994; 107(3): 732 - 742. [Abstract] [Full Text]