Which is the present role of surgical ablation of ventricular tachyarrhythmias in the ICD era?

In recent years the developement of several different and effective nonpharmacological therapeutic modalities has contributed significantly to modify the management strategies for drug refractory MVTAs. The MGSA has been widely used in last years for the treatment of ischemic MVTAS. However in the past decade the ICD has been more and more used and now it can be considered the most widely used nonpharmacological therapy for these arrhythmias. We review our 7 year experience in the treatment of drug refractory MVTAs in 87 patients and report our results using MGSA or ICD. The MGSA was used in 37 patients with ischemic MVTAS. The best results were obtained with recently developed surgical techniques using computerized mapping systems. The perioperative mortality was abated (0% vs 20%) and the antiarrhythmic failure rate was reduced in selected pts with no more than 2 arrhythmogenic foci and a preserved LV function. The T-A for ICD implant was used in 16 pts: in this group we had a significant perioperative mortality (12.5%). The NT-A was utilized in 34 pts and no perioperative death occurred. No sudden cardiac death occurred in the ICD pts during the follow-up. In conclusion the present role of MGSA has been greatly reduced by the advent of new generation ICDs with non-thoracotomic lead systems which represent a real alternative to MGSA especially in pts with high surgical risks. It is possible that the role of MGSA will be further reduced by the improvements of radiofrequency catheter ablation technique.