Long-term efficacy of subendocardial resection in refractory ventricular tachycardia: relationship to site of arrhythmia origin.

Subendocardial resection is performed in patients with ventricular tachycardia (VT), but its efficacy as related to the site of origin of VT is problematic. We analyzed the efficacy of subendocardial resection in 24 patients with coronary artery disease and VT. All patients underwent preoperative and intraoperative mapping before subendocardial resection. Postoperative electrophysiologic studies were performed in the drug-free state 7 to 14 days after subendocardial resection. Group 1 (n = 14) had anterior, septal, or lateral sites of origin, and Group 2 (n = 10) had inferior or posterior sites of origin. Localization of presystolic electrical activity during VT by preoperative and intraoperative mapping was comparable in both groups (100%). Resectability of the site of origin was higher in Group 1. Induction of VT during a postoperative electrophysiological study was higher in Group 2. Perioperative mortality was comparable. Postoperative antiarrhythmic therapy was instituted more frequently in Group 2. Actuarial survival analysis showed improved patient survival at one year after subendocardial resection for both groups. The efficacy of subendocardial resection is related to site of origin of VT: Subendocardial resection is less efficacious in VT with inferior or posterior sites of origin because of nonresectability of the arrhythmogenic area.