Subendocardial resection for refractory ventricular tachycardia: effects on ambulatory electrocardiogram, programmed stimulation and ejection fraction, and relation to outcome.

The inducibility of ventricular tachycardia by programmed stimulation was correlated with ventricular ectopic activity on ambulatory electrocardiogram, ejection fraction and clinical outcome in 36 patients after endocardial resection for medically refractory ventricular tachycardia. Ventricular tachycardia was noninducible postoperatively in 25 patients and was inducible in 11. After administration of antiarrhythmic drugs, ventricular tachycardia could no longer be induced in four patients and remained inducible in the other seven patients. All 36 patients had postoperative and 20 had preoperative ambulatory electrocardiograms obtained while they were not receiving drug therapy. Pre- and postoperative ambulatory electrocardiograms did not differ in mean hourly ventricular premature depolarization frequency, Lown arrhythmia grade or change in grade (pre- vs. postoperative). The majority of postoperative patients had repetitive forms of ventricular arrhythmia postoperatively and there was no difference between patients with inducible and noninducible ventricular tachycardia in regard to Holter monitoring characteristics. There was no significant difference in postoperative ejection fraction between patients with inducible and noninducible ventricular tachycardia postoperatively. Ventricular tachycardia has recurred in 2 of 29 patients who had no inducible tachycardia at the time of hospital discharge and were followed up for a mean of 1 year; it has recurred in one of seven patients in whom it was still inducible at the time of hospital discharge and who were followed up for a mean of 7 months.(ABSTRACT TRUNCATED AT 250 WORDS)