[Anesthesia and surveillance in intracavitary fulguration for radical treatment of ventricular tachycardia].

Endocavitary fulguration, is a new technique to ablate the arrhythmogenic substrate of chronic ventricular tachycardias (VT). This method is used in patients with ventricular tachycardias of varied etiologies. 47 fulgurations in 36 patients with 40 hemodynamic and 12 myocardial metabolic studies are presented. In cardiopathies, the cardiac performance is altered with an ejection fraction of less than 50% and a ventricular function curve which is in Braunwald zone II. Ablation of the arrhythmia was obtained in 63% of cases. Severe complications were observed in 13% of cases, i.e.: low cardiac output, pulmonary oedema and myocardial ischemia. Three patients died from cardiac failure. Ventricular tachycardia was induced to localize the arrhythmogenic foci to be fulgurated. Ventricular tachycardia led to hemodynamic changes with a high pulmonary capillary wedge pressure and low cardiac output (-21%) which was further lowered under general anesthesia (-42%) due to poor response to tachycardia. Endocardial fulguration per se induced severe but transient (less than 5 minutes) hemodynamic changes and was sometimes complicated by myocardial ischemia and conduction disorders. General anesthesia is necessary to perform endocardial fulguration but cannot be induced with a poor hemodynamic state and with high rate ventricular tachy-arrhythmias. Three criteria are used concerning the anesthetic agents: 1) maintainance of cardiac contractility and baro-reflex efficiency; 2) respect of myocardial oxygen balance; 3) maintainance of excitability during mapping of arrhythmogenic foci. Hemodynamic monitoring is necessary to understand and manage complications due to this new type of therapy.