Surgical ablation of XXXX with sequential map-guided subendocardial resection: electrophysiologic assessment and long-term follow-up.

@entity1 @entity1455 @entity1165 @entity583 @entity943 @entity2318 @entity591 @entity453 @entity204
A new operative technique of sequential map-guided subendocardial resection (SER) was used in 45 consecutive @entity1 for the treatment of sustained @entity1165 due to @entity453 . This technique is characterized by map-guided SER or cryothermic ablation during normothermic cardiopulmonary bypass, followed by repeated sequences of programmed stimulation to assess adequacy of resection. The @entity1 ' mean age was 59 +/- 10 years and the mean left ventricular ejection fraction was 34 +/- 12%. Twenty-five (56%) @entity1 had a history of @entity583 within the previous 2 months. After ventriculotomy, 34 @entity1 (76%) had inducible monomorphic @entity1165 . These @entity1 underwent repeated sequences of @entity1165 induction and mapping during normothermic bypass followed by successive SER or cryothermic ablation until sustained monomorphic @entity1165 was no longer inducible. Twenty-seven @entity1 had a total of 60 discrete, mappable @entity591 induced and seven @entity1 had 10 discrete @entity591 that were too fast to accurately map. In the remaining 11 @entity1 , no @entity1165 was inducible after ventriculotomy and SER, which included all visually identifiable @entity2318 , was performed. The mean cardiopulmonary bypass time was 102 +/- 27 min. Forty-one of 45 @entity1 (91%) survived to hospital discharge, and 35 of 41 @entity1 (85%) had no inducible @entity1165 at postoperative electrophysiologic evaluation performed in the absence of all antiarrhythmic drugs. The remaining six @entity1 had no inducible @entity1165 with drug therapy. All four operative nonsurvivors had refractory cardiac collapse preoperatively. Over 19 +/- 12 months of follow-up, there were four sudden @entity204 and no nonfatal recurrences of @entity1165 . There were seven additional @entity204 . Actuarial cardiac survival was 0.57, and freedom from arrhythmic events was 0.76 at 42 months. Thus, in the absence of @entity1455 , the technique of sequential map-guided SER achieves: (1) a high operative survival with acceptable perfusion times, (2) excellent long-term @entity943 control, and (3) survival comparable to that in @entity1 with similar left ventricular function and no history of @entity1165 .
