van Hemel N M
St. Antonius Hospital, Nieuwegein, The Netherlands.
Clin Cardiol. 1991 May;14(5):422-4. doi: 10.1002/clc.4960140511.
There is strong evidence that recurrent symptomatic ventricular tachycardia (VT) after acute myocardial infarction is associated with a poor prognosis (1-year mortality varying from 12% to 54%). When successive drug trials fail to suppress VT, cardiac surgery is considered but its therapeutical value appears disputable. Recent studies show inhospital mortality after surgery varying from 5% to 23%, and the 5-year actuarial survival ranging from 33% to 71%. However, using the quality of the residual left ventricular function as criterion for operability, our recent inhospital mortality diminished to 1.3%, while the 4-year actuarial survival was 85%. Arrhythmia freedom without drugs after 4 years after surgery is nowadays about 75%. These findings show that cardiac surgery might be a very acceptable alternative therapy in surgical candidates, in particular when one or more risk factors become apparent after acute myocardial infarction. This article describes the current position of arrhythmia surgery in relation to drug therapy and the implantable automatic defibrillator.
有强有力的证据表明，急性心肌梗死后复发性症状性室性心动过速（VT）与预后不良相关（1年死亡率在12%至54%之间）。当连续的药物试验未能抑制室性心动过速时，会考虑心脏手术，但其治疗价值似乎存在争议。最近的研究表明，手术后的住院死亡率在5%至23%之间，5年精算生存率在33%至71%之间。然而，以残余左心室功能的质量作为可操作性的标准，我们最近的住院死亡率降至1.3%，而4年精算生存率为85%。术后4年无药物心律失常的发生率目前约为75%。这些发现表明，心脏手术对于适合手术的患者可能是一种非常可接受的替代治疗方法，特别是当急性心肌梗死后出现一个或多个危险因素时。本文描述了心律失常手术相对于药物治疗和植入式自动除颤器的当前地位。
