Effect of surgery on ventricular tachyarrhythmias associated with coronary arterial occlusive disease.

We studied 51 patients with coronary artery disease over a 32-month period to determine the effect of coronary revascularization or ventricular resection on ventricular tachyarrhythmias. In these patients, whose major indications for operation were tachyarrhythmias, operative mortality was 18% (9/51). Myocardial infarction could not be documented in 16 patients, including four resuscitated from an arrest; 15 underwent coronary grafting, and one had grafting and mitral valve replacement, with one hospital death. Premature ventricular contractions (PVCs) persist in four of the 15 survivors; all those who had an arrest are free of PVCs. The other 35 patients had documented infarction, associated with an arrest in 19. Grafting only was required in 18, with no hospital mortality and two late deaths (congestive failure and ventricular tachyarrhythmia at 7 months, ventricular tachyarrhythmia at 5 months); eight of 16 survivors have PVCs. Acute (< 3 weeks) infarct resection was performed in six patients with three hospital deaths, no late deaths; one survivor has PVCs. Chronic (> 3 weeks) aneurysm resection in four patients (with bypass grafting in three) had no operative mortality, one late death (5 months) from ventricular tachyarrhythmias, and one survivor continues with PVCs. The remaining seven patients, all in cardiogenic shock, required more than two procedures (bypass grafting, LV resection, VSD closure, mitral valve replacement), with five hospital deaths; the two survivors still have PVCs. Thus, ventricular tachyarrhythmia secondary to coronary artery disease is more likely to resolve postoperatively in patients without myocardial infarction, but its postoperative persistence remains substantial and may warrant special efforts to locate and ablate ectopic foci and/or re-entry pathways.