Surgery for control of recurrent life-threatening ventricular tachyarrhythmias within 2 months of myocardial infarction

Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, England.

Twenty-seven patients (mean age 57 +/- 7 years) underwent surgery for control of recurrent drug-refractory ventricular tachyarrhythmias (uniform ventricular tachycardia alone in 9 patients, ventricular tachycardia and ventricular fibrillation in 15 and ventricular fibrillation alone in 3) within 2 months of acute myocardial infarction. The mean number of major arrhythmic episodes per patient was 15 (range 2 to 200) and of drug failures 4 +/- 2. Left ventricular function was severely impaired in the majority (ejection fraction 29%; range 14% to 47%) and 18 patients (66%) had a left ventricular aneurysm. Endocardial resection guided by a combination of endocardial activation mapping during tachycardia and fragmentation mapping during sinus rhythm was performed in all patients. All electrically abnormal left ventricular endocardium was excised. Eight patients (29.6%) died within 30 days of surgery. Death was not related to age, time of surgery after infarction, ventricular function, bypass time or type of arrhythmia. Patients requiring emergency surgery had a higher early postoperative mortality rate than did those undergoing planned surgery (43% versus 15%). During a follow-up period of 32 +/- 20 months, there have been no arrhythmic deaths and only three patients (16%) have required antiarrhythmic drug therapy. When required in the early weeks after infarction, surgery for ventricular arrhythmias offers a high cure rate at a risk related to the patient's preoperative arrhythmia frequency, which in turn relates to the risk of arrhythmic death.

This article has been cited by other articles:

				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]

				J P Bourke, R W F Campbell, J M McComb, S S Furniss, J C Doig, and C J Hilton Surgery for postinfarction ventricular tachycardia in the pre-implantable cardioverter defibrillator era: early and long term outcomes in 100 consecutive patients Heart, August 1, 1999; 82(2): 156 - 162. [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 P Bourke, A Loaiza, G Parry, C Hilton, S Furniss, J Dark, and J Forty Role of orthotopic heart transplantation in the management of patients with recurrent ventricular tachyarrhythmias following myocardial infarction Heart, November 1, 1998; 80(5): 473 - 478. [Abstract] [Full Text]