Most reports of operations for ventricular
arrhythmia have dealt with patients with anterior
myocardial infarction. Patients with previous remote
inferior myocardial infarction and recurrent
ventricular tachycardia or fibrillation are a difficult subset of patients to treat with surgical ablative procedures. Over a 2 year period, 11 patients with prior
inferior myocardial infarction and
drug-refractory
ventricular tachycardia or fibrillation underwent elective operation to control the
arrhythmia. Five patients had monomorphic
ventricular tachycardia. Three of these five patients had localized endocardial resection and/or cryoablative procedures when the
ventricular tachycardia was well localized intraoperatively. In the remaining two patients,
ventricular tachycardia was noninducible intraoperatively, and the patients underwent extensive endocardial resection and mitral valve replacement because of sites suspected near the posterior papillary muscle from preoperative
catheter mapping. None of these five patients had inducible
ventricular tachycardia postoperatively, and all are clinically free of the
arrhythmia over a 24 month follow-up period. One patient with two morphologies of
ventricular tachycardia previously had an unsuccessful blind endocardial resection. She underwent map-directed
cryoablation of both sites of
ventricular tachycardia. Postoperatively, the patient was free of inducible
arrhythmia and has been asymptomatic over 8 months. Five patients had pleomorphic
ventricular tachycardia or fibrillation that could not be electrically localized. One patient with
ventricular fibrillation underwent extensive endocardial resection, but the posterior papillary muscle was spared. Postoperative electrophysiological study was positive. The patient has had no clinical ventricular arrhythmias on a regimen of
amiodarone, however. Two patients had extensive endocardial resection and mitral valve replacement. One died early in the postoperative course and the other is clinically well. The remaining two patients had an encircling endocardial ventriculotomy. Both are clinically stable although one had inducible
ventricular fibrillation postoperatively. We conclude that well-defined monomorphic
ventricular tachycardia in patients with a previous
inferior myocardial infarction can be successfully treated with localized endocardial resection and/or
cryoablation. However, patients with poorly localized monomorphic
ventricular tachycardia or pleomorphic
ventricular tachycardia or fibrillation may require more extensive procedures. The role of posterior papillary muscle sacrifice with mitral valve replacement remains undefined.(ABSTRACT TRUNCATED AT 400 WORDS)