Transmitral Approach to Monopolar Radiofrequency Ablation of Inferior Papillary Muscle for Refractory Ischemic Ventricular Tachycardia

Despite the proven effectiveness of antiarrhythmic drugs and automated implantable cardioverter-defibrillators for ischemic ventricular arrhythmias, ablative procedures still play a major role. Herein, we report the cases of 2 patients who had malignant ventricular arrhythmias secondary to ischemic heart disease. The arrhythmias were treated intraoperatively by means of surgical ablation through a transmitral approach.Key words: Arrhythmias, cardiac/surgery; ventricular dysfunctionAlthough amiodarone and automated implantable cardioverter-defibrillator (AICD) therapy have proved effective for the treatment and prevention of malignant ischemic ventricular tachycardia, ablative procedures still play a major role.^1,2The site of origin of the left ventricular (LV) arrhythmia can greatly affect the complexity of surgical ablation. Whenever possible, intraoperative electrophysiologic mapping through a left ventriculotomy should precede ablation. Should the papillary muscles be the arrhythmogenic focus, their position inside the ventricle is an anatomic obstacle to endocardial resection, which can lead to severe mitral regurgitation.³We report 2 cases of ischemic heart disease in patients who developed malignant arrhythmias intraoperatively. These arrhythmias were treated by surgical ablation via a transmitral approach.