Intraoperative laser photocoagulation of ventricular tachycardia.

Mapping-guided laser photocoagulation was used as an intraoperative technique to treat ventricular tachycardia (VT) in patients with ischemic heart disease. Laser irradiation was delivered during VT to sites identified with local diastolic activation or, if VT was not inducible, to sites identified with delayed potentials during sinus rhythm. The group consisted of 12 male and two female patients who ranged in age from 41 to 74 years (mean, 59.9 years). All of the patients had experienced myocardial infarction before surgery; in eight cases myocardial infarction was associated with an anterior wall aneurysm, and in one case it was associated with a posterior wall aneurysm. Identified sites for laser irradiation were restricted to the endocardium in only four patients, whereas six patients showed endocardial and epicardial foci and four of them without circumscript aneurysm were subjected only to epicardial laser photocoagulation. Resection of an aneurysm was performed in nine patients, and additional bypass grafting (one to four grafts) has been performed in 10 patients. There were two perioperative deaths. Laser photocoagulation has proved to be an efficacious method for the surgical treatment of VT. It gives access to epicardial sites and, in particular, allows limited surgery in patients with restricted left ventricular function and no circumscript aneurysm.