Successful clinical laser ablation of ventricular tachycardia: a promising new therapeutic method.

This preliminary report describes 5 consecutive patients operated on for drug-resistant ventricular tachycardia (VT). All were successfully treated with laser photocoagulation ablation alone. The continuous-wave neodymium:yttrium-aluminum garnet (Nd:YAG) laser (wavelength, 1.06 micron) was chosen because of its capability for controlled deep tissue penetration, which can be adjusted by manipulating the power and exposure time of the beam. All patients had severe coronary artery disease. Preoperative left ventricular ejection fractions were low (0.18 to 0.29). Risk factors associated with increased failure rates by conventional surgical approaches were frequent: absence of discrete left ventricular aneurysm (5 patients) and multiple VT morphologies with disparate sites of origin (4 patients). All patients recovered fully. VT was not inducible prior to discharge, and no patient was placed on a regimen of antiarrhythmic drugs. Current direct surgical approaches to drug-resistant VT have markedly improved operative results compared with indirect procedures. However, failures and mortality remain high. Laser photocoagulation obviates some of the problems associated with conventional methods. It is similar to cryotherapy in that the structural integrity of affected tissues is maintained. In contrast to cryosurgery, however, laser photocoagulation is achieved more rapidly and with more precise myocardial destruction. One of the most promising features of laser coagulation is that it is administered to the perfused normothermic heart. Consequently, each morphological form of induced VT is observed to disappear as its area of origin is systematically located by mapping and then ablated.