The surgical treatment of ventricular tachycardias. Simple aneurysmectomy versus electrophysiologically guided procedures.

Between 1971 and 1982, 41 patients were operated upon for recurrent sustained ventricular tachycardia. All but three had severe coronary artery disease with a history of myocardial infarction. In 10 patients (Group I) simple aneurysmectomy with or without aorta-coronary bypass grafting was done. Thirty-one patients (Group II) had an electrophysiologically guided procedure, mainly partial or complete encircling endocardial ventriculotomy (EEV) at the earliest source of electrical activity during ventricular tachycardia. The results in the two groups indicate a clear superiority of electrophysiologically guided procedures over a simple aneurysmectomy regarding early and late disappearance of tachycardiac rhythm problems (p = 0.01); the differences between the two groups in hospital mortality (p = 0.43) and long-term survival are not significant. We compared our data with results in 160 cases of simple aneurysmectomy and 224 cases of electrophysiologically guided operations recently published in the literature. This comparison confirms the higher efficiency of mapping-guided procedures in eradicating ventricular tachycardias. The improvements in hospital and long-term survival, again, are not significant.