Trappe H J, Klein H, Wenzlaff P, Frank G, Siclari F, Götte A, Lichtlen P R
Department of Cardiology, University Hospital Hannover, Germany.
Pacing Clin Electrophysiol. 1993 Jan;16(1 Pt 2):242-6. doi: 10.1111/j.1540-8159.1993.tb01569.x.
The role of ventricular tachycardia (VT) surgery has been changed since the automatic implantable cardioverter defibrillator (ICD) is available. We studied the follow-up of 131 patients who underwent mapping guided surgery due to recurrent VT refractory to antiarrhythmic drug treatment. There were 65 patients operated upon between 1980-1985 (group I) and 66 patients between 1986-1991 (group II). Ten patients (8%) died perioperatively (< 3 weeks after surgery) [7/65 patients, 11%, in group I and 3/66 patients, 5%, in group II (P = 0.15)]. During a mean follow-up of 41 +/- 24 months, 38 of 121 patients died (31%), significantly more patients in group I (24/58 patients, 41%) than in group II (14/63 patients, 22%) (P < 0.05). In group I, there was a higher incidence of sudden (7/58 patients, 12%) or cardiac death (15/58 patients, 26%) than in group II (sudden death 4/63 patients, 6%, cardiac death 7/63 patients, 11%) (P < 0.05). There was a similar incidence of VT recurrences between group I (9/65 patients, 14%) and group II (9/66 patients, 14%). Our data show that the indication for VT surgery has changed since the ICD is available because of better patient selection.
自从自动植入式心脏复律除颤器（ICD）问世以来，室性心动过速（VT）手术的作用已经发生了变化。我们对131例因抗心律失常药物治疗无效的复发性VT而接受标测引导手术的患者进行了随访。1980年至1985年间有65例患者接受手术（第一组），1986年至1991年间有66例患者接受手术（第二组）。10例患者（8%）在围手术期死亡（术后<3周）[第一组65例患者中有7例，11%；第二组66例患者中有3例，5%（P = 0.15）]。在平均41±24个月的随访期间，121例患者中有38例死亡（31%），第一组死亡患者（58例患者中有24例，41%）显著多于第二组（63例患者中有14例，22%）（P < 0.05）。在第一组中，猝死（58例患者中有7例，12%）或心源性死亡（58例患者中有15例，26%）的发生率高于第二组（猝死63例患者中有4例，6%；心源性死亡63例患者中有7例，11%）（P < 0.05）。第一组（65例患者中有9例，14%）和第二组（66例患者中有9例，14%）的VT复发率相似。我们的数据表明，自从ICD问世以来，由于更好的患者选择，VT手术的适应证已经发生了变化。
