Surgical treatment of ventricular tachycardia

We present our clinical experience with 37 patients presenting with ventricular tachycardia who, between 1980 and 1986, underwent subendocardial resection, guided by per-operative mapping in 34 cases. An aneurysm of the left ventricle was present in 23 patients (62%), and an akinetic area in the remaining 14 patients. In every case the cause of ventricular tachycardia was an ischaemic heart disease. Prior to surgery, the global isotopic ejection fraction was 27 +/- 11% and the left ventricular end-diastolic pressure was 21 +/- 8 mmHg. The most common site of origin of the arrhythmia was the septum (26 cases, 77%). The mean area of resection was 26 +/- 16 cm2. Resection of a ventricular aneurysm was also performed in 23 cases, and 22 patients underwent coronary bypass. There were 4 early deaths (operative mortality rate : 10.8%) and 4 late deaths. The actuarial survival rate was 89 +/- 5% at 6 months and 72 +/- 9% at 24 months. One-half of the deaths was due to recurrence of the ventricular tachycardia. A post-operative electrophysiological study conducted in 30 patients proved negative in 28 (93%). Altogether, there were 6 immediate or late failures (16.2%) after a mean follow-up period of 18 months. The probability of a relapse-free, medication-free life or sudden death was 86 +/- 6% after 6 months and 82 +/- 7% after 24 months. The quality of life of the survivors war remarkable, since 86% of them (25/29 patients) remained in functional class 1 or 2 after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)