Surgical
therapy with mapping-guided subendocardial resection was used in 30 patients with
drug-refractory
ventricular tachycardia. Results of preoperative, intraoperative and postoperative electrophysiologic evaluation and long-term clinical follow-up are reported. Left ventricular
aneurysm was located in the inferior wall in 8 patients and in the anterior wall in 22. Left ventricular mapping was performed in 15 patients preoperatively and in all 30 patients intraoperatively. Subendocardial resection was supplemented with
cryoablation in 26 patients and with
laser photocoagulation in 4. Coronary bypass surgery was performed in 27 patients. The surgical mortality rate was 10%; the three deaths were due to
cardiogenic shock,
pneumonia and
sepsis, respectively. At postoperative electrophysiologic study,
ventricular tachycardia was inducible in 8 (30%) of 27 patients. Previously ineffective
antiarrhythmic drugs were effective in preventing the induction of
ventricular tachycardia in four of these eight patients. Two of the remaining four patients received an automatic implantable cardioverterdefibrillator; the other two were treated with
amiodarone. At a mean follow-up period of 18 +/- 17 months (range 1 to 52), there has been one
sudden death and one nonfatal recurrence of
ventricular tachycardia in the 18 patients without inducible arrhythmias postoperatively. Among the eight patients with inducible
ventricular tachycardia after subendocardial resection, there has been one nonfatal
ventricular tachycardia recurrence. Thus, among the 27 patients surviving surgery, 17 (63%) were cured with surgery alone, and another 7 (26%) had their
ventricular tachycardia controlled with drugs (n = 5) or the
defibrillator (n = 2). Inability to completely map the
tachycardia, a clinical history of
cardiac arrest requiring
resuscitation and the presence of
myocardial infarction within 2 months predicted postoperative
arrhythmia inducibility and recurrence.