Surgical treatment of ventricular tachycardias. Complete versus partial encircling endocardial ventriculotomy.

Forty consecutive patients underwent electrophysiologically guided encircling endocardial ventriculotomy as treatment for recurrent sustained ventricular tachycardia resulting from coronary artery disease and previous myocardial infarction. Twelve patients (30%, Group I) had a complete encircling endocardial ventriculotomy and 28 (70%, Group II) had a partial encircling endocardial ventriculotomy (54.4% +/- 2.2% of the left ventricular endocardial circumference) at the earliest electrical activation during ventricular tachycardia. There were no significant differences between the two groups in age, sex ratio, New York Heart Association class, coronary disease, aneurysm location, concomitant bypass grafting, and left ventricular function. One patient of Group I and two patients of Group II did not survive the perioperative period (8% versus 7%, not significant). The survivors were restudied electrophysiologically about 3 weeks after the operation. Eight patients of Group I and 19 patients of Group II were free of ventricular tachycardia (no spontaneous or inducible ventricular tachycardia) without antiarrhythmic drugs (73% versus 73%, not significant). The mean follow-up period in Group I is 22.6 months and in Group II, 15.2 months. Five patients of Group I and of Group II developed severe left ventricular dysfunction (46% versus 8%; p = 0.025). Also, congestive heart failure was a significant cause of death in Group I patients (p = 0.036). In conclusion, electrophysiologically guided partial encircling endocardial ventriculotomy is highly efficient as a surgical treatment of recurrent sustained ventricular tachycardia. Complete encircling endocardial ventriculotomy offers no better ablation of arrhythmias and should be avoided because of its apparent hazards to left ventricular performance.