Treatment of Malignant Ventricular Arrhythmias with Endocardial Resection and Implantation of the Automatic Cardioverter-Defibrillator

Although ventricular resection guided by endocardial mapping has been a successful treatment for drug-refractory ventricular arrhythmias, 20 to 30 percent of patients still have postoperative sustained ventricular tachycardia or sudden death. To improve the outcome of the procedure, we implanted an automatic cardioverter-defibrillator in conjunction with endocardial resection in 28 patients, all of whom had had previous myocardial infarctions and between one and five cardiac arrests. There were three perioperative deaths. During follow-up of 8 to 51 months (mean, 25), 4 of the 25 survivors had recurrences of hypotensive ventricular tachycardia, which in all instances were automatically terminated by the implanted device. One patient, whose automatic cardioverter-defibrillator was not functional, died suddenly. We conclude that patients undergoing mapping-directed endocardial resection can be provided with additional protection against recurrent ventricular tachyarrhythmias or sudden death by implantation of an automatic cardioverter-defibrillator. (N Engl J Med 1986; 314:213–6.), Ventricular resection guided by endocardial mapping is an important advance in the management of drug-refractory ventricular tachycardia.^1,2 This technique and modifications of it are now carried out at a number of centers, with results that are favorable overall.^{2 3 4 5 6} However, the incidence of sudden death or recurrent sustained ventricular tachycardia in patients who have undergone endocardial resection is still 20 to 30 percent.^{1 2 3 4 5} We have supplemented endocardial resection with implantation of an automatic cardioverter-defibrillator in an effort to lower this figure.^{7 8 9 10 11 12} The purpose of this communication is to report our experience in 28 such patients. Methods Patient Population The study group…