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(Circulation. 1997;96:4307-4313.)
© 1997 American Heart Association, Inc.

Articles

Ventricular Tachycardia in Valvular Heart Disease

Facilitation of Sustained Bundle-Branch Reentry by Valve Surgery

Calambur Narasimhan, MD; Mohammad R. Jazayeri, MD; Jasbir Sra, MD; Anwer Dhala, MD; Sanjay Deshpande, MD; Michael Biehl, MD; Masood Akhtar, MD; ; Zalmen Blanck, MD

From the Electrophysiology Laboratories, University of Wisconsin–Milwaukee Clinical Campus, Sinai Samaritan and St Luke's Medical Centers, Milwaukee, Wis.

Correspondence to Zalmen Blanck, MD, 2901 West Kinnickinnic River Pkwy, Suite 470, Milwaukee, WI 53215.

Background The clinical characteristics of sustained monomorphic ventricular tachycardia (SMVT), when it develops after valve surgery, have not been described.

Methods and Results Between 1985 and 1996, 31 patients (30 men and 1 woman) who had undergone valve surgery were found to have inducible SMVT. Nine patients (29%) had sustained VT due to bundle-branch reentry (BBR) (group 1). Four of these patients had normal left ventricular function, and VT with a right bundle-branch morphology was inducible in 4 patients. Group 2 included 20 patients with inducible myocardial (ie, non-BBR) VT. Coronary artery disease was present in 15 group 2 patients (75%) due to atherosclerotic (n=12) and nonatherosclerotic (n=3) causes. Two patients had both inducible sustained BBR and myocardial VT (group 3). Sustained BBR VT occurred significantly earlier after valve surgery (median, 10 days) than the onset of postoperative myocardial VT (median, 72 months; P<.005).

Conclusions Myocardial VT was the most common type of inducible SMVT in patients with valvular heart disease. The majority of these patients had underlying coronary artery disease and significant left ventricular dysfunction. However, in almost one third of the patients, sustained BBR VT was the only type of inducible SMVT. This type of VT was facilitated by the valve procedure occurring within 4 weeks after surgery in most patients. In these patients, left ventricular function was relatively well preserved, and the right bundle-branch block type of BBR was frequently induced. Because a curative therapy can be offered to these patients (ie, bundle-branch ablation), BBR should be seriously considered as the mechanism of VT in patients with valvular heart disease, particularly if the arrhythmia occurs soon after valve surgery.

Key Words: ablation • valves • heart disease • tachycardia • bundle-branch reentry