Ventricular tachycardia surgery: Difference between revisions
Jump to navigation
Jump to search
Line 7: | Line 7: | ||
== | ==[[Revascularization]] Procedures in Patients With [[Ischemic Heart Disease]]== | ||
* [[Myocardial ischemia]] is a substrate for sustained [[polymorphic VT]], [[VF]] | * [[Myocardial ischemia]] is a substrate for sustained [[polymorphic VT]], [[VF]] | ||
* Revascularization is a treatment of choice for [[myocardial ischemia]]. | * [[Revascularization]] is a treatment of choice for [[myocardial ischemia]]. | ||
* Survival after [[CABG]] for life-threatening [[ventricular arrhythmia]] | * [[Survival]] after [[CABG]] for life-threatening [[ventricular arrhythmia]] was reasonable. | ||
* For [[patients]] with [[ischemic heart disease]] and reduced [[LVEF]] undergoing [[CABG]] the risk of [[sudden cardiac death]] lessened compared with [[medical therapy]]. | * For [[patients]] with [[ischemic heart disease]] and reduced [[LVEF]] undergoing [[CABG]] the risk of [[sudden cardiac death]] lessened compared with [[medical therapy]]. | ||
* In survival of [[SCD]] the risk of [[death]] reduced by [[revascularization]] procedure including [[PCI]] or [[CABG]]. | * In survival of [[SCD]] the risk of [[death]] reduced by [[revascularization]] procedure including [[PCI]] or [[CABG]]. | ||
Line 16: | Line 16: | ||
* Anomalous [[aortic]] origin of the [coronary arteries ]] detected in 10% to 17% of [[patients]] in [[postmortem ]] studies, is an important cause of [[SCD]] in the [[young]]. | * Anomalous [[aortic]] origin of the [coronary arteries ]] detected in 10% to 17% of [[patients]] in [[postmortem ]] studies, is an important cause of [[SCD]] in the [[young]]. | ||
* [[Revascularization]] is recommended for treating [[ischemia]] leading life-threatening [[ventricular arrhythmia]] due to anomalous [[aortic]] origin of the [[coronary arteries]]. | * [[Revascularization]] is recommended for treating [[ischemia]] leading life-threatening [[ventricular arrhythmia]] due to anomalous [[aortic]] origin of the [[coronary arteries]]. | ||
==[[Surgery]] for [[arrhythmia]] management== | |||
* [[Cardiac surgery]] is rarely performed for treating [[ventricular tachycardia]] in case of highly symptomatic [[patients]] with failed antiarrhythmic medications or [[ventricular]] [[ablation]]. | |||
* Inaccessible sites for [[ventricular ablation]] including area deep in the [[myocardium]], beneath [[epicardial]] fat, or near the [[coronary arteries ]]. | |||
* [[Surgical ablation ]] of [[ventricular arrhythmia]] can be done during other surgical [[intervention ]] such as placement of [[LVAD]] or at the time of [[left ventricular]] [[aneurysectomy]] which is a substrate for [[VT]]. | |||
==[[ Autonomic Modulation]]== | |||
==Surgery== | ==Surgery== |
Revision as of 05:57, 9 May 2021
Ventricular tachycardia Microchapters |
Differentiating Ventricular Tachycardia from other Disorders |
---|
Diagnosis |
Treatment |
Case Studies |
Ventricular tachycardia surgery On the Web |
Risk calculators and risk factors for Ventricular tachycardia surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery is not a mainstay or a preferred method of treatment for ventricular tachycardia. There are some specific scenarios however in which revascularization may be considered, and may help in preventing VT.
Revascularization Procedures in Patients With Ischemic Heart Disease
- Myocardial ischemia is a substrate for sustained polymorphic VT, VF
- Revascularization is a treatment of choice for myocardial ischemia.
- Survival after CABG for life-threatening ventricular arrhythmia was reasonable.
- For patients with ischemic heart disease and reduced LVEF undergoing CABG the risk of sudden cardiac death lessened compared with medical therapy.
- In survival of SCD the risk of death reduced by revascularization procedure including PCI or CABG.
- Ischemic heart disease is responsible for 24% to 55% of SCD cases in young patients <35 years of age.
- Anomalous aortic origin of the [coronary arteries ]] detected in 10% to 17% of patients in postmortem studies, is an important cause of SCD in the young.
- Revascularization is recommended for treating ischemia leading life-threatening ventricular arrhythmia due to anomalous aortic origin of the coronary arteries.
Surgery for arrhythmia management
- Cardiac surgery is rarely performed for treating ventricular tachycardia in case of highly symptomatic patients with failed antiarrhythmic medications or ventricular ablation.
- Inaccessible sites for ventricular ablation including area deep in the myocardium, beneath epicardial fat, or near the coronary arteries .
- Surgical ablation of ventricular arrhythmia can be done during other surgical intervention such as placement of LVAD or at the time of left ventricular aneurysectomy which is a substrate for VT.
Autonomic Modulation
Surgery
According to a few studies and opinions, patients with ventricular tachycardia may be considered for surgery (revascularization) if the underlying cause is coronary heart disease and the patient:[1][2][3][4][5]
- Does not respond to antiarrhythmic drug therapy.
- Has had a cardiac arrest in the past, and had monomorphic VT. This is especially desirable in patients who are already being considered for surgical revascularization.
- Has ventricular tachycardia and a disorder that is pathophysiologically related to the VT (such as postoperative tetralogy of Fallot).
- Despite these ideas, revascularization alone has not been shown to prevent VT from recurring.
References
- ↑ Sartipy U, Albåge A, Strååt E, Insulander P, Lindblom D (January 2006). "Surgery for ventricular tachycardia in patients undergoing left ventricular reconstruction by the Dor procedure". Ann. Thorac. Surg. 81 (1): 65–71. doi:10.1016/j.athoracsur.2005.06.058. PMID 16368337.
- ↑ Guiraudon G, Fontaine G, Frank R, Leandri R, Barra J, Cabrol C (November 1981). "Surgical treatment of ventricular tachycardia guided by ventricular mapping in 23 patients without coronary artery disease". Ann. Thorac. Surg. 32 (5): 439–50. doi:10.1016/s0003-4975(10)61775-4. PMID 7305530.
- ↑ Sartipy U, Löfving A, Albåge A, Lindblom D (June 2008). "Surgery for ventricular tachycardia and left ventricular aneurysm provides arrhythmia control". Scand. Cardiovasc. J. 42 (3): 226–32. doi:10.1080/14017430802005240. PMID 18569956.
- ↑ Horowitz LN, Harken AH, Josephson ME, Kastor JA (July 1981). "Surgical treatment of ventricular arrhythmias in coronary artery disease". Ann. Intern. Med. 95 (1): 88–97. doi:10.7326/0003-4819-95-1-88. PMID 7018338.
- ↑ Doenst T, Faerber G, Grandinac S, Kuntze T, Menicanti L, Borger MA, Mohr FW (June 2007). "Surgical therapy of ventricular arrhythmias". Herzschrittmacherther Elektrophysiol. 18 (2): 62–7. doi:10.1007/s00399-007-0561-1. PMID 17646937.