Treatment of Ventricular Arrhythmias: Surgery
During the past five years, the surgical approach to the treatment of ventricular arrhythmias associated with coronary heart disease has undergone a dramatic change in terms of patient selection, surgical indications, and the specific surgical techniques employed to alleviate these lifethreatening arrhythmias. Because of the dismal results obtained using indirect surgical techniques for the treatment of refractory ischemic ventricular tachycardia prior to 1978, three new direct endocardial surgical procedures guided by intraoperative electrophysiologic mapping were introduced. The encircling endocardial ventriculotomy (EEV) of Guiraudon, the endocardial resection procedure (ERP) of Harken and its modification of “extended” ERP by Moran, and endocardial cryoablation introduced by our group at Duke University have all proven to be superior to the previous indirect surgical procedures. The operative mortality rate has been decreased from 27% to approximately 10% and the overall success rate has been increased from 50% to 90% with the introduction of the direct surgical procedures. Although each of these direct endocardial techniques is effective, the selection of the appropriate procedure for a given patient depends upon the electro physiologic characteristics of the ventricular arrhyhtmia and on its anatomic “site of origin” in the left ventricle. As these procedures have been shown to be safer and more effective than the previous indirect operations, the indications for surgical therapy of refractory ischemic ventricular tachycardia have been expanded.
KeywordsCatheter Depression Ischemia Amiodarone Dial
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