Garan H, Nguyen K, McGovern B, Buckley M, Ruskin J N
J Am Coll Cardiol. 1986 Jul;8(1):201-9. doi: 10.1016/s0735-1097(86)80113-9.
Thirty-six patients underwent ventricular aneurysmectomy and electrophysiologically directed endocardial resection for treatment of recurrent ventricular tachycardia refractory to antiarrhythmic drug therapy. The surgical mortality rate was 17% and all 30 patients discharged from the hospital were alive at the end of the follow-up period (range 6 to 54 months), yielding a cumulative projected survival rate of 83% by actuarial analysis. Poor systolic function of the nonaneurysmal ventricular segments was the strongest and the only independent predictor of operative mortality among the clinical, hemodynamic, angiographic and electrophysiologic variables analyzed by stepwise logistic regression. Ventricular tachycardia recurred early in four of the six patients in whom the endocardial resection was limited to a small area for technical reasons. Twelve patients, including 10 with sustained ventricular tachycardia still inducible by postsurgical programmed electrical stimulation, were discharged receiving antiarrhythmic drugs that had been tried unsuccessfully before surgery. During a mean follow-up period of 25 +/- 15 months, nonfatal sustained ventricular tachycardia recurred in two patients after discharge. Inadequate endocardial resection was a significant predictor of arrhythmia recurrence.
三十六例患者接受了室壁瘤切除术及电生理指导下的心内膜切除术，以治疗对抗心律失常药物治疗无效的复发性室性心动过速。手术死亡率为17%，所有30例出院患者在随访期结束时（6至54个月）均存活，经精算分析累积预计生存率为83%。在通过逐步逻辑回归分析的临床、血流动力学、血管造影和电生理变量中，非瘤样心室节段的收缩功能差是手术死亡率最强且唯一的独立预测因素。由于技术原因，六例患者中有四例的心内膜切除术仅限于小面积，其中室性心动过速早期复发。十二例患者，包括10例术后程控电刺激仍可诱发持续性室性心动过速的患者，出院时接受了术前曾试用但未成功的抗心律失常药物。在平均25±15个月的随访期内，两名患者出院后出现非致命性持续性室性心动过速复发。心内膜切除不充分是心律失常复发的重要预测因素。
