Neodymium:YAG laser photocoagulation: a successful new map-guided technique for the intraoperative ablation of ventricular tachycardia.

Neodymium:YAG laser photocoagulation was used in the intraoperative treatment of drug-resistant ventricular tachycardia (VT) in 17 consecutive patients. The cause of VT was previous myocardial infarction in 15, sarcoid in one, and idiopathic in one patient. Electrophysiologic studies were performed preoperatively, before hospital discharge, and 8 to 12 weeks and 1 year after surgery. At surgery, laser photocoagulation was performed on the normothermic heart during VT. Surgical mortality was 11.7%. There was one late nonarrhythmic death 35 days postoperatively. There were 55 VT morphologies. Laser successfully abated 52 of 55. Associated use of cryoablation was required in two of 55. One VT in the patient with sarcoidosis was not successfully ablated but was controlled by procainamide. In the long-term survivors with VT due to myocardial infarction the surgical cure rate was 100%, i.e., no spontaneous or inducible VT. Follow-up ranges from 6 to 18 months (mean 11.8 +/- 4.3). Nd:YAG laser photocoagulation is an effective addition to the operative treatment strategies for VT.