May support feasibility in severe LV dysfunction with VT; leaves open need for RCTs versus contemporary ablation or device strategies.
Key Points
To evaluate the efficacy and feasibility of an aggressive surgical approach combining map-directed ablation, scar resection, and revascularization for recurrent ventricular tachycardia in patients with coronary disease.
Analyzed 54 consecutive patients aged ≤65 years (mean age 56 ± 7 years) presenting with coronary artery disease, prior myocardial infarction, and recurrent ventricular tachycardia.
Performed map-directed ablation (endocardial excision in 82% [44/54], cryoablation in 60% [32/54]), scar excision, left ventricular remodeling, coronary bypass grafting, and staged mitral valve replacement when necessary.
Severe left ventricular dysfunction (ejection fraction <0.40) occurred in 89% (48/54) of patients (mean ejection fraction 0.28 ± 0.12), while only 63% (34/54) had resectable aneurysms on preoperative angiograms.
Preoperative morbidity included syncope or presyncope in 83% (45/54), extensive coronary artery disease in 78% (42/54), angina in 54% (29/54), and congestive heart failure in 52% (28/54).
Cite This Study
Mickleborough et al. (1992) studied this question.