This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Josephson, M. E. Articles by Horowitz, L. N. Search for Related Content PubMed PubMed Citation Articles by Josephson, M. E. Articles by Horowitz, L. N.

Circulation, Vol 60, 1430-1439, Copyright © 1979 by American Heart Association

ARTICLES

Endocardial excision: a new surgical technique for the treatment of recurrent ventricular tachycardia

ME Josephson, AH Harken and LN Horowitz

Twelve patients with medically refractory ventricular tachycardia secondary to ischemic heart disease underwent surgery for cure of their arrhythmia. Preoperatively, the tachycardia could be reproducibly initiated and terminated in each patient by programmed stimulation. In all instances, intraoperative mapping localized the tachycardia to the border of the aneurysm, a site not routinely resected during aneurysmectomy. In nine instances, the area of origin involved the septum. During bypass the tachycardia could still be induced after standard aneurysmectomy or ventriculotomy in 11 of 12 patients. On the basis of intraoperative mapping, resection of endocardium in the area of origin (25--40% the circumference of the aneurysmectomy) up to normal muscle was performed. In one patient without a discrete aneurysm, endocardial excision alone through a ventriculotomy was performed. There was one operative death due to cardiogenic shock (preoperative ejection fraction 5%) and one late death due to rupture of a mycotic aneurysm in the pulmonary artery. Before discharge, all patients underwent a repeat relectrophysiologic study off antiarrhythmic agents and in none could ventricular tachycardia be initiated. Hemodynamic and angiographic catheterization showed improved hemodynamics and ejection fractions in all. The 10 survivors remained free of sustained ventricular tachycardia for 9--20 months, with one late nonarrhythmic death.

This article has been cited by other articles:

				K. Seo, M. Inagaki, S. Nishimura, I. Hidaka, M. Sugimachi, T. Hisada, and S. Sugiura Structural Heterogeneity in the Ventricular Wall Plays a Significant Role in the Initiation of Stretch-Induced Arrhythmias in Perfused Rabbit Right Ventricular Tissues and Whole Heart Preparations Circ. Res., January 8, 2010; 106(1): 176 - 184. [Abstract] [Full Text] [PDF]

				E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]

				H. J. Wellens Forty Years of Invasive Clinical Electrophysiology: 1967-2007 Circ Arrhythm Electrophysiol, April 1, 2008; 1(1): 49 - 53. [Full Text] [PDF]

				L. W. Stephenson History of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 3 - 28. [Full Text]

				D. Lindblom, A. Albage, and U. Sartipy Surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration MMCTS, December 17, 2007; 2007(1217): 2816. [Abstract] [Full Text] [PDF]

				M. Cotrufo, G. Romano, L. S. De Santo, A. D. Corte, C. Amarelli, G. Cafarella, C. Maiello, and M. Scardone Treatment of extensive ischemic cardiomyopathy: quality of life following two different surgical strategies Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 481 - 487. [Abstract] [Full Text] [PDF]

				H. J.J. Wellens Cardiac arrhythmias: The quest for a cure: A historical perspective J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1155 - 1163. [Abstract] [Full Text] [PDF]

				M. Josephson and H. J.J. Wellens Implantable Defibrillators and Sudden Cardiac Death Circulation, June 8, 2004; 109(22): 2685 - 2691. [Full Text] [PDF]

				L. W. Stephenson History of Cardiac Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 3 - 29. [Full Text]

				J P Bourke, R W F Campbell, J M McComb, S S Furniss, J C Doig, and C J Hilton Surgery for postinfarction ventricular tachycardia in the pre-implantable cardioverter defibrillator era: early and long term outcomes in 100 consecutive patients Heart, August 1, 1999; 82(2): 156 - 162. [Abstract] [Full Text] [PDF]

				T. Nitta, R. B. Schuessler, M. Mitsuno, C. K. Rokkas, F. Isobe, C. S. Cronin, J. L. Cox, and J. P. Boineau Return Cycle Mapping After Entrainment of Ventricular Tachycardia Circulation, March 31, 1998; 97(12): 1164 - 1175. [Abstract] [Full Text] [PDF]

				S. J. Shumway, E. M. Johnson, C. A. Svendsen, J. M. Kriett, and W. S. Ring Surgical Management of Ventricular Tachycardia Ann. Thorac. Surg., June 1, 1997; 63(6): 1589 - 1591. [Abstract] [Full Text]

				H. Rastegar, M. S. Link, C. B. Foote, P. J. Wang, A. S. Manolis, and N.A. M. Estes Perioperative and Long-term Results With Mapping-Guided Subendocardial Resection and Left Ventricular Endoaneurysmorrhaphy Circulation, September 1, 1996; 94(5): 1041 - 1048. [Abstract] [Full Text]

				M. Eldar, A. P. Fitzpatrick, D. Ohad, M. F. Smith, S. Hsu, J. G. Whayne, Z. Vered, Z. Rotstein, T. Kordis, D. K. Swanson, et al. Percutaneous Multielectrode Endocardial Mapping During Ventricular Tachycardia in the Swine Model Circulation, September 1, 1996; 94(5): 1125 - 1130. [Abstract] [Full Text]

				H. A. Rajasinghe, H. P. Lorenz, M. T. Longaker, M. M. Scheinman, and S. H. Merrick Arrhythmogenic Ventricular Aneurysms Unrelated to Coronary Artery Disease Ann. Thorac. Surg., May 1, 1995; 59(5): 1079 - 1084. [Abstract] [Full Text]

				V. Dor, M. Sabatier, F. Montiglio, P. Rossi, A. Toso, and M. Di Donato Results of nonguided subtotal endocardiectomy associated with left ventricular reconstruction in patients with ischemic ventricular arrhythmias J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1301 - 1308. [Abstract] [Full Text]

				M. E. Josephson and A. H. Kadish Uses and Abuses of Electrophysiologic Testing in the Management of Ventricular Arrhythmias J Intensive Care Med, September 1, 1987; 2(5): 235 - 238. [Abstract] [PDF]

				P. C. Nalos, M. R. Myers, E. S. Gang, T. Peter, and W. J. Mandel Analytic Reviews: Electrophysiologic Testing in the Intensive Care Unit J Intensive Care Med, September 1, 1987; 2(5): 241 - 259. [Abstract] [PDF]

				J. M. Herre Advances in the Management of Tachyarrhythmias J Intensive Care Med, March 1, 1987; 2(2): 65 - 75. [Abstract] [PDF]

				G. M. Lawrie, C. R. C. Wyndham, J. Krafchek, J. C. Luck, R. Roberts, and M. E. DeBakey Progress in the Surgical Treatment of Cardiac Arrhythmias: Initial Experience of 90 Patients JAMA, September 20, 1985; 254(11): 1464 - 1468. [Abstract] [PDF]

				B. MCGOVERN, H. GARAN, and J. N. RUSKIN Treatment of Ventricular Arrhythmias--Suppression, Survival, and the Problem of Bias Ann Intern Med, July 1, 1984; 101(1): 123 - 125. [Abstract] [PDF]

				M. Akhtar Management of Ventricular Tachyarrhythmias: Part II JAMA, February 26, 1982; 247(8): 1178 - 1181. [Abstract] [PDF]

				L. N. HOROWITZ, A. H. HARKEN, M. E. JOSEPHSON, and J. A. KASTOR Surgical Treatment of Ventricular Arrhythmias in Coronary Artery Disease Ann Intern Med, July 1, 1981; 95(1): 88 - 97. [Abstract] [PDF]

				I. WIENER Pacing Techniques in the Treatment of Tachycardias Ann Intern Med, August 1, 1980; 93(2): 326 - 329. [Abstract] [PDF]