Tachycardia: subendocardial resection and endoaneurysmorrhaphy was effective.

Clinical bottom line (level 4)

  1. A quarter of patients given subendocardial resection and left ventricular endoaneurysmorrhaphy for ventricular tachycardia died within 3 years.
  2. 8% of patients treated with subendocardial resection and endoaneurysmorrhaphy had inducible ventricular tachycardia at 1 week.
Rastegar et al: Circulation 1996; 94: 1041-1048
Expires October 2004

The study

Outcome study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital cardiology and surgery divisions, USA

25 patients (aged range 45 to 72 years; mean 60, 80% male) Sustained ventricular tachycardia with the presence of angiographically defined, discrete, inferior or anterior akinetic or dyskinetic segment of left ventricle appropriate for surgical resection.

Excluded if
  • received an implantable cardioverter defibrillator instead
  • no left ventricular aneurysms
  • catheter ablation of the ventricular tachycardia focus
  • taking an effective antiarrhythmic agent
  • non-inducible ventricular tachycardia


    • Preoperative and intraoperative mapping, and subendocardial resection were performed until ventricular tachycardia could no longer be induced. All patients underwent left ventricular reconstruction with a pericardial patch. All patients underwent repeated electrophysiological evaluation at about 1 week after surgery.

    100% followed for up to 3 years
    Outcomes studied:
  • total mortality
  • inducible ventricular tachycardia

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    total mortality up to 3 years 7/25 28%
    (10% to 46%)
    inducible ventricular tachycardia up to 3 years 2/25 8%
    (1.0% to 26%)

    • The mean left ventricular ejection fraction increased from 24% before surgery to 32% after surgery.

    Citation

    1. Rastegar H, Link MS, Foote CB, et al: Perioperative and long-term results with mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy. Circulation 1996; 94: 1041-1048
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient sustained ventricular tachycardia
    Intervention or Exposure mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy
    Outcome mortality and improvement in ventricular function