Surgical therapy of ventricular tachycardia

Abstract

Two-thirds of deaths in patients with heart disease occur suddenly, and the majority of these events result from ventricular tachyarrhythmias. Approximately one-half of patients with potentially lethal (i.e. sustained) ventricular tachycardia or fibrillation respond to pharmacologic therapy. Therefore, a large number of patients are potential candidates for more aggressive therapy of these arrhythmias, and this has led to a variety of surgical approaches to this problem. Techniques developed for control of sustained ventricular arrhythmias may be divided into specific and non-specific approaches. Initial experiences with nonspecific techniques including aorto-coronary bypass and dorsal sympathectomy, were associated with high failure rates and unacceptable operative mortality because they were based on the assumption that ventricular tachyarrhythmias resulted from the general disease state (e.g. coronary artery disease) rather than the specific mechanisms underlying these arrhythmias [1–5]. The one exception to this has been success of myocardial revascularization in the prevention of ventricular fibrillation and tachycardia precipitated by acute myocardial ischemia [6]. However, most sustained ventricular tachycardias do not appear to be precipitated by acute ischemia or other transient metabolic alterations. The association between sustained ventricular tachycardia and left ventricular aneurysms led to attempts at more specific therapy. Initially, non-directed left ventricular aneurysmectomy was performed [1,7–9].KeywordsVentricular TachycardiaVentricular TachyarrhythmiaSustained Ventricular TachycardiaVentricular Free WallVentricular AneurysmThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.