This Article Full Text 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 Pfeiffer, D. Articles by Luderitz, B. Search for Related Content PubMed PubMed Citation Articles by Pfeiffer, D. Articles by Luderitz, B. Pubmed/NCBI databases Medline Plus Health Information Heart Attack

(Circulation. 1996;94:3221-3225.)
© 1996 American Heart Association, Inc.

Articles

Epicardial Neodymium

YAG Laser Photocoagulation of Ventricular Tachycardia Without Ventriculotomy in Patients After Myocardial Infarction

Dietrich Pfeiffer, MD; Rainer Moosdorf, MD; Robert H. Svenson, MD; Laszlo Littmann, MD; Wolfram Grimm, MD; Paul G. Kirchhoff, MD; Berndt Luderitz, MD

the Departments of Cardiology (D.P., B.L.) and Cardiovascular Surgery (P.G.K.), University of Bonn, Germany; the Departments of Cardiac Surgery (R.M.) and Cardiology (W.G.), Philipps-University, Marburg, Germany; and the Carolinas Heart Institute, Charlotte, NC (R.H.S., L.L.).

Background Surgical ablation of ventricular tachycardia (VT) after myocardial infarction has been reported by different endocardial approaches. The ventriculotomy may increase mortality of the procedure.

Methods and Results We report on nine patients who suffered from recurrent VT in the late post–myocardial infarction period. Significant stenoses were detected in all patients. The mean left ventricular ejection fraction was 43.1±8.3%. Left ventricular scar (n=9) was seen. The mean NYHA class was 2.2±0.4. Sustained VT (mean cycle length, 293±52 ms) occurred spontaneously (n=9) and could be induced reproducibly. Catheter mapping detected a prematurity of -42±13 ms in six patients. Clinical VT was inducible during surgery in seven patients. Middiastolic potentials were detected from the epicardial surface (n=3), and premature potentials were found (n=8 with prematurity of -108±46 ms). Application of neodymium/yttrium/argon/garnet (Nd:YAG) laser energy to early epicardial activation terminated the arrhythmia (n=7). Ventriculotomy was not performed. Seven patients have been free of VT for a mean follow-up period of 17±11 months; one patient relapsed and was treated with an implantable cardioverter-defibrillator, as was a second patient with inducible VT after surgery.

Conclusions Surgical Nd:YAG laser photocoagulation of VT on the epicardial surface of the heart in post–myocardial infarction patients without ventriculotomy is safe and has a high success rate. At the present time, this method is recommended in patients with sustained and tolerated VT who need bypass surgery. This is the first report on epicardial laser ablation of VT in post–myocardial infarction VT.

Key Words: tachycardia • lasers • arrhythmia • surgery • death, sudden

This article has been cited by other articles:

				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]

				M. Mukaddirov, R. G. Demaria, L. P. Perrault, J.-M. Frapier, and B. Albat Reconstructive surgery of postinfarction left ventricular aneurysms: techniques and unsolved problems. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 256 - 261. [Abstract] [Full Text] [PDF]

				E. Sosa, M. Scanavacca, A. d'Avila, F. Oliveira, and J. A. F. Ramires Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1442 - 1449. [Abstract] [Full Text] [PDF]