Risk factors for the development of life-threatening ventricular arrhythmias following surgical reconstruction of the left ventricle

Rosseikin E.V., Kobzev E.E., Popylkova O.V., Durmanov S.S., Bazylev V.V.

Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia

Death in patients with postinfarction aneurysms of the left ventricle (LV) is mainly caused by life-threatening ventricular arrhythmias – ventricular tachycardias (VTs) and ventricular fibrillations (VFs). Surgical reconstruction of the LV may potentially lead to disruption of the re-entry mechanism, lying at the basis of ventricular tachyarrhythmias. A series of authors demonstrated high efficacy of such procedures as endocardectomy and radiofrequency ablation of the borderline zone of the LV. But high incidence of relapses, difficulty detecting the localization of VT and performing radiofrequency ablation (RFA), as well as high incidence of spontaneous and induced VTs in patients with postinfarction aneurysms of the LV have preserved dissatisfaction with the currently existing techniques.

The findings of several large studies have shown that placing an implantable cardioverter-defibrillator (ICD) makes it possible to prevent sudden cardiac death and improve the survival rate in patients with ischaemic cardiomyopathy. However, those studies did not include patients with less than 2-3 months having elapsed after the open operation.

In order to determine optimal terms of implantation of ICDs and to reveal independent predictors of an ICD’s triggering after surgical reconstruction of the LV we carried out a retrospective study of the outcomes of operative treatment of 84 patients divided into two groups: Group One comprised 63 patients found to have neither VFs nor VTs registered according to the findings of follow-up and Group Two included 21 patients with an ICD’s triggering registered. We assessed the medium-term survival, the time and frequency of ICDs’ triggering, as well as risk factors for onset of VF and VT.

KEY WORDS: left ventricle, reconstruction of the left ventricle, cardiac insufficiency.

P. 163

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