Surgical ablation of ventricular tachycardias

Summary

Summarizing the hospital mortality and the long-term results of antitachy-cardiac surgery by regarding the actuarial long-term survival after onset of disease or operation (Figure 11) antitachycardiac surgery has a beneficial effect in this highly problematic patient population with drug refractory VT, comparing the outcome with the above mentioned natural history. After an initially high early hospital mortality rate of about 14% the direct endocardial operations for ablating or isolating the underlying arrhythmogenic tissue can improve the prognosis significantly. Regarding the initially high operative risk we have to be aware, that this data are including the learning curves and that future results can be improved by considering the risk factors for mortality and recurrence of VT in the selection of appropriate candidates.

For patients with a predictable high risk of operation alternative procedures to the direct endocardial surgery such as the AICD, ablation techniques or cardiac transplantation should be discussed.

In case of an ischemic cause of VT, well defined inducible monomorphic VT, a discret area of dyskinesis or well demarked aneurysm and in case of a well preserved function of non aneurysmal ventricular wall the direct endomyocardial electrophysiological guided operation is at present still the therapy of choice with encouraging short- and long-term results compared with alternative therapies.