Morphologically distinct sustained ventricular tachycardias in coronary artery disease: significance and surgical results

One hundred patients with drug-refractory recurrent sustained ventricular tachycardia associated with coronary artery disease who underwent mapping-directed subendocardial resection for ventricular tachycardia were retrospectively evaluated with respect to a number of morphologically distinct tachycardias on a 12 lead electrocardiogram. Of 91 operative survivors, 18 patients had only one configuration of tachycardia, whereas 73 (81%) had multiple distinct tachycardia configurations; 36 had multiple configurations clinically. Patients with multiple clinical configurations had a longer mean HV interval (65 +/- 11 versus 53 +/- 10 ms, p less than 0.005) and a higher failure rate of surgery alone (47 versus 25% for single clinical tachycardia, p less than 0.05). The 13 patients whose multiple clinical tachycardias originated in disparate sites in the heart (greater than 5 cm between sites of origin) were less often cured by surgery alone than were those whose multiple tachycardias originated in the same or adjacent sites (83 versus 38% failure rate of surgery alone, p less than 0.05). On the basis of mapping data, multiple configurations of ventricular tachycardia appear to originate in the same or adjacent sites in the majority of patients, although in 16% of patients with multiple tachycardias, the tachycardias originate at widely separated sites.

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