Pagé P L
Division of Cardiovascular and Thoracic Surgery, hôpital du Sacré-Coeur de Montréal, Canada.
Arch Mal Coeur Vaiss. 1996 Feb;89 Spec No 1:115-21.
Despite the excellent results achieved with the endocardial resection procedure in the management of patients with life-threatening ventricular tachycardia. Most surgical electrophysiology teams have experienced a decline in the number of direct operations performed for life-threatening ventricular tachycardia. This is probably due to the widespread use of thrombolytic therapy during the acute phase of infarct formation. But also to the advent of implantable cardioverter-defibrillators that are increasingly sophisticated, easy to use and effective. Their increased use over the past few years is related to the belief that direct operations for the eradication of ventricular tachycardia foci bear a high operative mortality rate. However, today the operative mortality is less than 5%, and long term survival is up to 85% at 5 years with an extremely low incidence of ventricular tachycardia recurrence and sudden death. We report the results obtained in our first 100 patients in whom ventricular tachycardia surgical ablation was guided by computerized mapping of both the endocardium and epicardium. A particular type of ventricular tachycardia activation pattern was found to be associated with a higher rate of electrical failure due to a deep septal substratum. Appropriate management of this condition may further decrease the rate of ventricular tachycardia reinducibility and long term return of ventricular tachycardia to a level yet unachieved by any other therapeutic modality. The results of catheter ablation are promising, but access to intramural substrates remains unresolved. In patients with sustained monomorphic ventricular tachycardia associated with a discrete akinetic area of the left ventricle, surgery offered as a last resort is less likely to produce favourable results and the decision of its use should therefore be taken early before unjustified drug trials go on.
尽管在心内膜切除术治疗危及生命的室性心动过速患者方面取得了优异成果，但大多数心脏外科电生理团队进行的危及生命的室性心动过速直接手术数量有所下降。这可能是由于在梗死形成急性期广泛使用溶栓治疗，也归因于植入式心脏复律除颤器的出现，其越来越精密、易于使用且有效。在过去几年中其使用增加是因为人们认为根除室性心动过速病灶的直接手术手术死亡率很高。然而，如今手术死亡率低于5%，5年长期生存率高达85%，室性心动过速复发和猝死发生率极低。我们报告了在我们的首批100例患者中通过心内膜和心外膜的计算机标测指导进行室性心动过速手术消融所获得的结果。发现一种特殊类型的室性心动过速激活模式与由于深层间隔基质导致的电衰竭发生率较高有关。对这种情况进行适当处理可能会进一步降低室性心动过速可诱导性和室性心动过速长期复发率，使其达到任何其他治疗方式尚未达到的水平。导管消融的结果很有前景，但进入壁内基质的问题仍未解决。对于伴有左心室离散运动减弱区域的持续性单形性室性心动过速患者，作为最后手段的手术不太可能产生良好结果，因此应在不合理的药物试验进行之前尽早做出使用手术的决定。
