Relative efficacy of blind left ventricular aneurysm resection for the treatment of recurrent ventricular tachycardia.

Coronary arterial bypass grafting and left ventricular aneurysm resection and the two combined have been reported effective in control of refractory ventricular tachyarrhythmias; 82 percent of a pool of 127 patients (from 22 reports) survived after surgery. However, the follow-up period in this group is short and the extent of medical therapy is not well defined. Actuarial analysis of results of conventional left ventricular aneurysm resection in 32 Stanford patients with well documented ventricular tachyarrhythmias shows an arrhythmia recurrence rate of 50 +/- 9 percent (mean +/- standard error of the mean) during the postoperative hospitalization. In contrast, after 10 months only 11 +/- 9 percent of 18 patients who underwent myocardial resection guided by intraoperative electrical activation sequence mapping experienced arrhythmia recurrence. These data demonstrate that simple left ventricular aneurysm resection is less effective in preventing ventricular tachyarrhythmias than originally believed. Preliminary data suggest that surgery of the left ventricle guided by intraoperative mapping may provide more effective control of ventricular tachyarrhythmias. However, intraoperative mapping has many technical and interpretive problems. Investigations are needed to determine the roles of conventional and new operative approaches to treatment of medically refractory ventricular tachyarrhythmias.