Control of Intractable Ventricular Tachycardia by Coronary Revascularization

Ventricular tachycardia (VT) is an arrhythmia that has an ischemic origin in up to 74% of cases and results in a 42 to 67% mortality when it is recurrent and paroxysmal. Present therapy is aimed at suppression of the abnormal rhythm but does not alter the prognosis of the underlying ischemic heart disease. A new concept of treatment of VT is introduced that is based on direct coronary revascularization by the aorta to coronary, saphenous vein-bypass technique. The method was successfully applied in a 61-year-old man who developed episodes of VT 2 months after myocardial infarction. Maximal medical therapy in a coronary care unit for 26 days did not abolish the arrhythmia which occurred as frequently as seven times an hour. Coronary angiography and aortocoronary bypass grafting were done when the patient developed electrocardiographic and enzyme evidence of subendocardial myocardial infarction and symptoms of cerebral ischemia. The patient remains free of arrhythmia 1 year later, and his exercise capability is now normal for his age. Follow-up coronary angiography is presented. Coronary revascularization has been shown to abolish angina pectoris. This report demonstrates that aortocoronary bypass grafting can abolish an arrhythmia of ischemic origin. When persistent or recurrent VT fails to respond to all medical therapy, direct coronary revascularization should be considered to control this ischemic arrhythmia.