Iwa T, Misaki T, Kawasuji M, Matsunaga Y, Tsubota M, Matsumoto Y
Department of Surgery I, Kanazawa University School of Medicine, Japan.
Eur J Cardiothorac Surg. 1991;5(4):191-7; discussion 198. doi: 10.1016/1010-7940(91)90029-j.
Drug resistant, non-ischemic ventricular tachycardia (VT) was treated in 43 patients by direct surgery based on electrophysiological data. Two main surgical techniques were employed: myocardium was resected followed by cryocoagulation with a special probe in 23 patients with VT originating from the right ventricle. The myocardium was incised followed by cryocoagulation in 10 patients with VT from the left ventricle. The follow-up period ranged from 1 week to 10 years, 4 weeks (mean 3 years, 8 months). After operation, 36 patients (83%) showed complete disappearance of VT without antiarrhythmic therapy. Of these 2 patients died of congestive heart failure not related to VT in the postoperative period at 1 year 4 months, and 2 years 4 months, respectively. In 7 patients, VT remained. In 2, VT disappeared after catheter ablation. In 3 patients, VT became controllable with antiarrhythmic therapy. Operation was not successful in 2 patients (5%); 1 with a giant left ventricular aneurysm died of low cardiac output syndrome due to VT 1 week after operation; the other with arrhythmogenic right ventricular dysplasia originating from both ventricles died suddenly 5 months after operation. The 10-year survival is 89%, and the 10-year freedom from recurrent VT is 83%. These results indicate that surgical management for non-ischemic VT is safe and effective with a high chance of cure.
43例耐药性非缺血性室性心动过速（VT）患者接受了基于电生理数据的直接手术治疗。采用了两种主要手术技术：23例右心室起源的室性心动过速患者先切除心肌，然后用特殊探头进行冷冻凝固。10例左心室起源的室性心动过速患者先切开心肌，然后进行冷冻凝固。随访期为1周~10年，平均3年8个月（4周）。术后，36例患者（83%）在未接受抗心律失常治疗的情况下室性心动过速完全消失。其中2例分别于术后1年4个月和2年4个月死于与室性心动过速无关的充血性心力衰竭。7例患者仍有室性心动过速。2例经导管消融后室性心动过速消失。3例患者通过抗心律失常治疗使室性心动过速得到控制。2例患者手术未成功（5%）；1例巨大左心室动脉瘤患者术后1周因室性心动过速死于低心排血量综合征；另1例双心室起源的致心律失常性右心室发育不良患者术后5个月突然死亡。10年生存率为89%，10年无复发性室性心动过速率为83%。这些结果表明，非缺血性室性心动过速的手术治疗安全有效，治愈几率高。
