Surgery for Non-Ischemic Ventricular Tachycardia

概要

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Objective: Radiofrequency catheter ablation of non-ischemic VT frequently fails because of a possible non-transmural ablation due to an epicardial or intramural activation focus or hypertrophic myocardium. Methods: Surgeries for non-ischemic VT were performed in 17 patients from 2002 to 2011. The underlying heart diseases were cardiomyopathy in 11 patients, an idiopathic LV aneurysm in 2, an LV lipoma in 2, idiopathic VT in 1, and ARVC in 1. The indication for the surgery was medically refractory or incessant VT in all, including in 10 patients with VT storms. Ten patients had an ICD or CRTD implanted preoperatively and 10 had undergone a failed endocardial and/or epicardial RFCA. In the patients with HCM, the thickness of the LV at the origin of the VT was 14.3±1.9 mm. All the patients underwent a map-guided procedure for VT. Results: There were no operative or late deaths. The intraoperative electro-anatomical mapping demonstrated epicardial or intramural origin or reentry in the HCM patients. There was one early recurrence of clinical VT and an additional endocardial RFCA was performed. Three patients were inducible of non-clinical VT or VF, and an ICD was implanted. There were no recurrences of VT or ICD shocks in any patients during a follow-up period of 42±33 months. Conclusions: The surgery provides an excellent suppression of VT in the patients with non-ischemic VT.