Postinfarction Ventricular Tachycardia Research Articles

Medical and surgical treatment of sustained and recurrent post-infarction ventricular tachycardia.

Over a five-year period 57 patients (pts) with sustained, recurrent, post-infarction ventricular tachycardia (VT) refractory to conventional antiarrhythmic treatment were evaluated. In 28 (49%) pts VT was controlled by amiodarone (A) in a dose of 3000 mg week-1. During long-term follow-up 5/28 (18%) pts died; no severe side-effects were observed with this dosage. In 17 of the 29 pts not controlled by this regimen, the dosage of A was increased to 6000-8000 mg week-1; short-term control of VT was achieved in 9/17 (53%) pts, but over a long-term follow-up 5/9 (56%) died and severe side-effects (11% pulmonary fibrosis and 11% hepatitis) occurred in 22%. Twenty pts, resistant to a low (12 pts) or high (8 pts) doses of A, underwent map-guided surgical treatment. In conclusion A is superior to conventional drugs in the treatment of sustained, recurrent, post-infarction VT, but when high doses are necessary to prevent VT, long-term results are poor and severe side-effects frequent. In pts refractory to standard doses of A, map-guided surgery is the treatment of choice.

Aneurysmectomy in treatment of ventricular and supraventricular tachyarrhythmias in patients with postinfarction and traumatic ventricular aneurysms

Serious, refractory or recurrent, or both, paroxysmal tachyarrhythmia occurred in 8 of 33 consecutive patients with a diagnosis of left ventricular aneurysm established by angiocardiography. The arrhythmia was ventricular in origin in five patients and supraventricular in three. Six of the eight patients were operated upon and the aneurysms resected. Four patients survived the operation and had no recurrence of the arrhythmias during a follow-up period of 7 to 25 months. One of these patients had a traumatic myocardial aneurysm associated with ventricular tachyarrhythmia. The other three patients had postinfarction aneurysms; ventricular tachycardia had been present in two and recurrent atrial flutter in the third. Two patients died after operation. They differed from the surviving patients in that they both had three-vessel coronary artery disease and severe impairment of myocardial contractility. Two patients responded satisfactorily to medical treatment so that surgery was not considered necessary. One of these had a postinfarction aneurysm and ventricular tachycardia that recurred less frequently with antiarrhythmic therapy. The other had a traumatic myocardial aneurysm and supraventricular tachycardia that was adequately controlled with drugs. Aneurysmectomy should be considered in the management of patients with postinfarction or traumatic ventricular aneurysms who present with refractory ventricular or supraventricular tachycardia.