Candinas R, Welter M, Gloor H O, Amann F W, von Segesser L, Turina M
Departement Innere Medizin, Kardiologie, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1993 Sep 4;123(35):1631-9.
We reviewed the data of 42 consecutive patients (mean age 55 +/- 12 years) who underwent surgery for control of recurrent drug-refractory ventricular arrhythmia. A history of myocardial infarction was present in 38 patients, 4 patients had congenital heart disease (2 aneurysms, 1 right ventricular dysplasia, 1 hamartoma). The mean LV ejection fraction was 40 +/- 14%. At preoperative electrophysiologic study, ventricular tachycardia was inducible in 32 of 33 patients. The mean heart rate was 188/min. A mean of 3.3 +/- 2.1 antiarrhythmic drug trials were ineffective. The most frequently performed surgical procedure (n = 36) was visually guided subendocardial resection, alone or in combination with cryothermal ablation. In 30 patients additional aneurysmectomy was performed. A mean of 1.9 +/- 1.4 coronary arteries in 32 patients were bypassed. The overall in-hospital mortality (30 days) was 9.5% (1 arrhythmic death, 1 pump failure, 1 sepsis, 1 hemorrhagic shock). We found 2 significant (p < 0.05) predictors of perioperative mortality: recent myocardial infarction and patient's age. During a mean follow-up of 33 months (range 1 to 90), there were 3 sudden cardiac deaths and 6 nonfatal recurrences of ventricular tachycardia which were subsequently prevented with antiarrhythmic drug therapy. Thus, the overall success in control of arrhythmia was 92%, in 59% by surgery alone. Survival was 79% at 2 years after surgery and 63% at 5 years. We conclude that patients who have successful subendocardial resection and aneurysmectomy for control of ventricular arrhythmia have an excellent chance of arrhythmia-free survival and a relatively good prognosis.
我们回顾了42例连续接受手术以控制复发性药物难治性室性心律失常患者的数据（平均年龄55±12岁）。38例患者有心肌梗死病史，4例患者有先天性心脏病（2例动脉瘤、1例右心室发育不良、1例错构瘤）。左心室射血分数平均为40±14%。术前电生理研究显示，33例患者中有32例可诱发出室性心动过速。平均心率为188次/分钟。平均3.3±2.1次抗心律失常药物试验无效。最常施行的手术（n = 36）是直视下的心内膜下切除术，单独或联合冷冻消融术。30例患者还进行了动脉瘤切除术。32例患者平均有1.9±1.4支冠状动脉接受了搭桥手术。总的住院死亡率（30天）为9.5%（1例心律失常死亡、1例泵衰竭、1例脓毒症、1例失血性休克）。我们发现围手术期死亡率的2个显著（p < 0.05）预测因素：近期心肌梗死和患者年龄。在平均33个月（范围1至90个月）的随访期间，有3例心源性猝死和6例室性心动过速非致命复发，随后通过抗心律失常药物治疗得以预防。因此，心律失常控制的总体成功率为92%，其中仅手术控制的成功率为59%。术后2年生存率为79%，5年生存率为63%。我们得出结论，成功进行心内膜下切除术和动脉瘤切除术以控制室性心律失常的患者有极好的无心律失常生存机会和相对良好的预后。
