Does the availability of the ICD and subsequent changes in patient selection improve mortality outcomes in patients undergoing mapping-guided surgery for recurrent VT?
The availability of ICDs likely improved patient selection for VT surgery, resulting in significantly lower long-term mortality despite similar rates of VT recurrence.
The role of ventricular tachycardia (VT) surgery has been changed since the automatic implantable cardioverter defibrillator (ICD) is available. We studied the follow-up of 131 patients who underwent mapping guided surgery due to recurrent VT refractory to antiarrhythmic drug treatment. There were 65 patients operated upon between 1980-1985 (group I) and 66 patients between 1986-1991 (group II). Ten patients (8%) died perioperatively (< 3 weeks after surgery) 7/65 patients, 11%, in group I and 3/66 patients, 5%, in group II (P = 0.15). During a mean follow-up of 41 +/- 24 months, 38 of 121 patients died (31%), significantly more patients in group I (24/58 patients, 41%) than in group II (14/63 patients, 22%) (P < 0.05). In group I, there was a higher incidence of sudden (7/58 patients, 12%) or cardiac death (15/58 patients, 26%) than in group II (sudden death 4/63 patients, 6%, cardiac death 7/63 patients, 11%) (P < 0.05). There was a similar incidence of VT recurrences between group I (9/65 patients, 14%) and group II (9/66 patients, 14%). Our data show that the indication for VT surgery has changed since the ICD is available because of better patient selection.
Trappe et al. (1993) studied this question.