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Ann Thorac Surg 1994;58:1291-1296
© 1994 The Society of Thoracic Surgeons

Articles

Direct operation versus ICD therapy for ischemic ventricular tachycardia

T.Bruce Ferguson, Jr, MD*, Joseph M. Smith, MD, James L. Cox, MD, Michael E. Cain, MD, Bruce D. Lindsay, MD

Division of Cardiothoracic Surgery, Department of Surgery, and Section of Electrophysiology, Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA

* Address reprint requests to Dr Ferguson, Division of Cardiothoracic Surgery, Washington University School of Medicine, Suite 3108 Queeny Tower, #1 Barnes Hospital Plaza, St. Louis, MO 63110.

Now that the implantable cardioverter defibrillator is available as a therapeutic option for the management of ventricular tachycardia (VT), some argue that there no longer should be a role for direct surgical intervention for this malignant arrhythmia. Rebuttal of this argument is difficult for the following reasons: (1) there are many patients who are candidates for implantable cardioverter defibrillator therapy but not for direct VT operation, and thus direct comparisons of the two therapies is difficult; (2) implantable cardioverter defibrillator therapy by definition is palliative, but a VT operation is curative in most instances; (3) in many electrophysiologic triage algorithms, implantation of a cardioverter defibrillator and VT operation are employed as alternative, not competitive, therapies, again making direct comparisons difficult; and (4) probably most importantly, there are misconceptions in the literature regarding the risks and benefits of direct VT surgical procedures as they are currently performed. In this brief review, we examine the currently available data on both sides of this argument.




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