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Surgical therapy of ventricular arrhythmias

Chirurgische Therapie ventrikulärer Herzrhythmusstörungen

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Zusammenfassung

Seit implantierbare Defibrillatoren (ICD) und perkutane Ablationstechniken zur Routine geworden sind, ist die chirurgische Therapie ventrikulärer Herzrhythmusstörungen in den Hintergrund getreten. Trotzdem ist sie weiterhin erforderlich, insbesondere bei Patienten, bei denen ein ICD sich öfter entlädt oder die eine andere Indikation für einen herzchirurgischen Eingriff haben. Die Wahl der chirurgischen Therapie reicht dabei von Radiofrequenz- oder Kryoablation eines einzelnen arrhythmogenen Fokus über größere Eingriffe, wie eine Ventrikelrekonstruktion mit Endokardresektion, bis hin zur kompletten Resektion des rechten Ventrikels und der Schaffung einer cavopulmonalen Zirkulation bei maligner Arrhythmie im Rahmen der rechtsventrikulären Dysplasie. Die jeweilige Wahl der Therapie sollte dabei von der Pathogenese abhängen. Dies ist wichtig, da jede Inzision in den rechten oder linken Ventrikel selbst wieder eine Ursache ventrikulärer Arrhythmien darstellen kann. In diesem Übersichtsartikel werden die Hauptgründe für eine ventrikuläre Arrhythmie, die Indikation für einen chirurgischen Eingriff und die daraus resultierenden Ergebnisse beschrieben. Es wird geschlossen, dass in den meisten Fällen eine Ischämie die Ursache für die Arrhythmie darstellt und dass eine Revaskularisation mit Ventrikelrekonstruktion und Endokardresektion die beste chirurgische Behandlung zu sein scheint.

Abstract

Since the advent of implantable cardioverters/defibrillators (ICD) and percutaneous ablation, surgery for the treatment of ventricular arrhythmia has decreased tremendously. Nevertheless, surgical treatment of ventricular arrhythmias is still required, especially for cases where ICD discharge occurs very frequently or in patients with other indications for surgery. The choice of surgical therapy may range from radiofrequency- or cryoablation of a single focus (identified either intra- operatively or percutaneously) to more extensive surgical procedures such as surgical ventricular reconstruction with endocardial resection or even resection of the right ventricle and the creation of a cavo-pulmonary circulation for malignant arrhythmias and right ventricular failure in patients with arrhythmogenic right ventricular dysplasia. However, the choice of surgical procedure should be made based on the pathomechanism of the arrhythmia. This is important because any incision in the left or right ventricle or percutaneous ablation may also be the cause for ventricular arrhythmia. In this short review we will describe the most common underlying substrates for ventricular arrhythmia, indications for surgery, the techniques used for treatment and the results achieved. We will conclude that for most cases of patients with ventricular arrhythmia undergoing surgery, ischemia and the presence of a scar after myocardial infarction is the underlying cause and revascularization plus surgical ventricular reconstruction with endocardial resection may be the best treatment option.

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Authors and Affiliations

  1. Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    T. Doenst MD, G. Faerber, T. Kuntze, M. A. Borger & F. W. Mohr

  2. Dedinje Cardiovascular Institute, Belgrade, Serbia

    S. Grandinac

  3. San Donato Hospital, Milano, Italy

    L. Menicanti

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  1. T. Doenst MD
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  2. G. Faerber
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  3. S. Grandinac
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  4. T. Kuntze
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  5. L. Menicanti
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  6. M. A. Borger
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  7. F. W. Mohr
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Correspondence to T. Doenst MD.

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Doenst, T., Faerber, G., Grandinac, S. et al. Surgical therapy of ventricular arrhythmias. Herzschr. Elektrophys. 18, 62–67 (2007). https://doi.org/10.1007/s00399-007-0561-1

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  • DOI: https://doi.org/10.1007/s00399-007-0561-1

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