Endocardial Resection for Ventricular Tachycardia and Ventricular Fibrillation

Abstract

The treatment of cardiac dysrhythmias has always been primarily the concern of the physician, but despite considerable recent advances in the medical treatment of ventricular tachycardias (VT) and ventricular fibrillation (VF) there remains a proportion of patients in whom the dysrhythmia remains refractory to current drugs administered either alone or in combination. For these patients surgical treatment is an attractive alternative. The early methods of surgical treatment yielded unpredictable results [1–3]. The more recently evolved techniques of intra-operative electro-physiological mapping followed by either encircling endocardial ventriculotomy or endocardial resection have markedly improved the results in monomorphic VT [4, 5] but their role in polymorphic VT and VF remains uncertain. We will present our experience of electrophysiologically guided resection in the management of eight patients, six of whom fall into this difficult category. Prior to our first venture into the surgery of ventricular dysrhythmias we decided to use endocardial resection rather than encircling ventriculotomy as we envisaged technical problems where the areas of abnormal activation were on the septum or involved both ventricles.