One hundred patients with drug-refractory recurrent sustained ventricular tachycardia associated with coronary artery disease who underwent mapping-directed subendocardial resection for ventricular tachycardia were retrospectively evaluated with respect to a number of morphologically distinct tachycardias on a 12 lead electrocardiogram. Of 91 operative survivors, 18 patients had only one configuration of tachycardia, whereas 73 (81%) had multiple distinct tachycardia configurations; 36 had multiple configurations clinically. Patients with multiple clinical configurations had a longer mean HV interval (65 ± 11 versus 53 ± 10 ms, p < 0.005) and a higher failure rate of surgery alone (47 versus 25% for single clinical tachycardia, p < 0.05). The 13 patients whose multiple clinical tachycardias originated in disparate sites in the heart (> 5 cm between sites of origin) were less often cured by surgery alone than were those whose multiple tachycardias originated in the same or adjacent sites (83 versus 38% failure rate of surgery alone, p < 0.05). On the basis of mapping data, multiple configurations of ventricular tachycardia appear to originate in the same or adjacent sites in the majority of patients, although in 16% of patients with multiple tachycardias, the tachycardias originate at widely separated sites.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine