Guiraudon G, Fontaine G, Frank R, Leandri R, Barra J, Cabrol C
Ann Thorac Surg. 1981 Nov;32(5):439-50. doi: 10.1016/s0003-4975(10)61775-4.
Twenty-three patients with resistant ventricular tachycardia not related to coronary artery disease underwent surgical treatment guided by ventricular mapping. The patients were grouped according to radiological and anatomical findings. Group 1 (13 patients) had arrhythmogenic right ventricular dysplasia. Group 2 (3 patients) had left ventricular aneurysm. Group 3 (2 patients) had nonobstructive myocardiopathy. Group 4 (5 patients) had normal-appearing hearts. At operation all patients underwent ventricular mapping when in sinus rhythm and during ventricular tachycardia. The rationale of operation was ventriculotomy or cryosurgery at the site of origin of ventricular tachycardia or exclusion, resection, or undermining of arrhythmogenic areas where delayed potentials were observed. Four patients died during the perioperative period, 3 of low-output failure and 1 from bleeding. Ventricular tachycardia recurred immediately after operation in 4 patients, 3 of whom died during the perioperative period. Ventricular tachycardia recurred late in 5 patients. Three had only episodic, unsustained runs of tachycardia. Two were well controlled by drugs. All patients with ventricular tachycardia situated over the free wall of the ventricles had inducible ventricular tachycardia and had good surgical results. Three out of 5 patients with ventricular tachycardia situated in the septum had poor surgical results. Septal ventricular tachycardia needs a better surgical approach to the septum and a suitable surgical concept.
23例与冠状动脉疾病无关的顽固性室性心动过速患者接受了心室标测引导下的手术治疗。根据影像学和解剖学检查结果对患者进行分组。第1组（13例患者）患有致心律失常性右室发育不良。第2组（3例患者）患有左室动脉瘤。第3组（2例患者）患有非梗阻性心肌病。第4组（5例患者）心脏外观正常。手术时，所有患者在窦性心律和室性心动过速发作期间均接受了心室标测。手术的基本原理是在室性心动过速起源部位进行心室切开术或冷冻手术，或者在观察到延迟电位的致心律失常区域进行切除、排除或剥离。4例患者在围手术期死亡，3例死于低心排血量衰竭，1例死于出血。4例患者术后立即出现室性心动过速复发，其中3例在围手术期死亡。5例患者室性心动过速复发较晚。3例仅有阵发性、非持续性心动过速发作。2例通过药物得到良好控制。所有位于心室游离壁的室性心动过速患者均可诱发室性心动过速，手术效果良好。5例位于室间隔的室性心动过速患者中有3例手术效果不佳。室间隔室性心动过速需要更好的室间隔手术入路和合适的手术理念。
