Encircling endocardial resection for sustained drug-resistant ventricular tachycardia.

Localized endocardial resection guided by intraoperative mapping has been used recently to manage patients with drug-resistant ventricular tachycardia. Although not uniformly successful, this procedure is superior to simple aneurysmectomy. This report describes the authors' early experience with encircling endocardial resection with complete removal of endocardial scar in seven patients with drug-resistant, sustained, ventricular tachycardia, as identified by electrophysiologic studies. Intraoperative mapping was not used. Although no spontaneous clinical arrhythmia occurred after operation, ventricular tachycardia could be induced in one patient, but not after loading with procainamide. This was the only patient who required long-term antiarrhythmic therapy. There were no operative deaths, but one patient died 21/2 months after endocardial resection with recurrent ventricular septal defects and another died after 4 months. Our early experience indicates that encircling endocardial resection effectively eliminates re-entrant ventricular tachycardia and identifies ventricular septal defect as a potential postoperative complication following extensive septal endocardial resection.