Operative Management of Intractable Ventricular Tachyarrhythmias

Due to better catheter techniques and pharmacologic agents, operative intervention is not considered in most patients with arrhythmias, although it still has a definite role that is clearly life-saving in some situations. The implantable defibrillator has absolutely no role in patients with intractable arrhythmias. Multiple shocks are not well tolerated and the battery will wear out. However, both coronary bypass and endocardial resection have been used at our institution successfully for intractable arrhythmias. Another modality is the use of various types of temporary and permanent left ventricular support devices in patients who need time to have their arrhythmias treated pharmacologically. The devices are used to support the overall hemodynamic status of the patient. There is probably no worse scenario than to successfully treat the arrhythmia pharmacologically than to lose the patient to multiorgan failure due to hemodynamic instability. Therefore, it is proper that early institution of mechanical support be used in otherwise low-risk patients who have severe arrhythmias and who may be candidates for cardiac transplantation.