The Surgical Approach to Tachycardias

In cases of unresponsiveness of supra- or ventricular tachycardia to antiarrhythmic drug treatment, antitachycardia pacemakers or map-guided surgical procedures may become alternative therapies. The Wolff-Parkinson-White(WPW) syndrome with episodes of atrial fibrillation and/or short refractory periods of the accessory pathway represent the main indication for surgical therapy of supraventricular tachycardias. We report on 19 patients undergoing surgical therapy for their atrial tachycardias. Sixteen patients had WPW syndrome and 3 had atrial flutter, junctional and left atrial ectopic tachycardia. A total of 20 accessory pathways were identified intraoperatively, 9 on the left and 11 on the right side. Eight patients were operated on using the closed heart technique without cardiopulmonary bypass. Fifteen of the 16 patients are free of tachycardias and PAT is not inducible. One patient had a delta wave without PAT and one had a spontaneous PAT relapse after surgery. Both patients had multiple accessory pathways identified intraoperatively. Endocardial resection or incision are the commonly used surgical procedures for medically refractory ventricular tachycardia. Sixty-eight patients, 62 with coronary disease, 5 with right and left ventricular dysplasia and one with sarcoidosis underwent map-guided surgery for their ventricular tachycardias. An encircling incision was performed in 14 patients, 48 of the patients had endocardial resection. In 18 patients, cryoablation was used either alone or in combination with other procedures. The early mortality rate was 12% (9 out of 68). The late mortality was 15% after a mean follow-up of 29 months. Five patients had a relapse of VT, one was reoperated successfully.