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Treatment of resistant ventricular tachycardia with endocavitary fulguration and antiarrhythmic therapy, compared to antiarrhythmic therapy alone: experience in 111 consecutive cases with a mean follow-up of 18 months.

Endocavitary fulguration was performed in 31 cases of high-risk ventricular tachycardia (VT) for which antiarrhythmics, including Amiodarone and Class-I antiarrhythmic agents, given alone or in combination, proved ineffective. Permanent VT was incessant in nine patients at the time of fulguration: five of these were moribund, and two were unconscious. Included in the series were ten cases of arrhythmogenic right ventricular dysplasia, 13 cases of chronic VT after myocardial infarction, five cases of idiopathic dilated cardiomyopathy, two cases of idiopathic VT, and one case that involved a congenital anomaly. Combined fulguration and antiarrhythmic therapy succeeded in preventing VT in the 27 patients who survived the initial period of treatment. Thirteen patients needed two or more sessions, however, before their VT was brought under control. Three of the four early deaths were probably related to an imperfect technique. Four late deaths were due to spontaneous evolution of the disease. One patient without cardiac failure died suddenly. The follow-up period ranged from a minimum of 13 to a maximum of 34 months, with an average follow-up of nearly 2 years. The success rate for fulguration alone or for antiarrhythmic drugs is about 90%. This group of patients is compared with a group that involved 73 less severe cases treated with drugs. Fulguration appears to be the better form of treatment.