Frank G, Klein H, Lichtlen P, Borst H G
Thorac Cardiovasc Surg. 1981 Oct;29(5):315-9. doi: 10.1055/s-2007-1023506.
The aim of surgical therapy for ventricular arrhythmias is to eliminate the areas of diseases myocardium from which ventricular tachycardias originate. According to the results of endocardial mapping a 2 to 3 mm deep endocardial incision is performed around the identified arrhythmogenic area. Within the past 12 months, 19 patients with coronary heart disease and complex ventricular arrhythmias were operated upon. In 16 cases an endocardial incision was performed. In 5 a left ventricular aneurysm was resected as well, 4 patients received one to 4 coronary vein grafts, and in 7 patients aneurysmectomy and bypass grafting were combined. Except for one relapse, no ventricular tachycardia has reappeared since the operation. Ventricular tachycardia could not be initiated by intracardiac stimulation postoperatively in any of the cases restudied. Four patients died from causes unrelated to ventricular arrhythmias. Direct surgical therapy was proven a promising new approach in patients with ventricular tachycardia or complex ventricular arrhythmia refractory to medical treatment. Our technique of endocardial incision appears to be effective and less traumatic to the myocardium than the original transmural encircling incision.
室性心律失常外科治疗的目的是消除室性心动过速起源的病变心肌区域。根据心内膜标测结果，在确定的致心律失常区域周围进行2至3毫米深的心内膜切口。在过去12个月中，对19例冠心病合并复杂室性心律失常患者进行了手术。16例进行了心内膜切口。5例同时切除了左心室动脉瘤，4例接受了1至4条冠状动脉静脉移植，7例同时进行了动脉瘤切除术和搭桥术。除1例复发外，术后无室性心动过速再次出现。在重新研究的任何病例中，术后心内刺激均不能诱发室性心动过速。4例死于与室性心律失常无关的原因。对于药物治疗无效的室性心动过速或复杂室性心律失常患者，直接手术治疗被证明是一种有前景的新方法。我们的心内膜切口技术似乎有效，且对心肌的创伤比原来的透壁环形切口小。
