Surgical management of cardiac arrhythmias

The role of surgery in the management of medically refractory cardiac arrhythmias has become well established during the past decade. Surgical techniques have been devised for the treatment of most types of supraventricular tachyarrhythmias and for both nonischemic and ischemic ventricular tachyarrhythmias. The development of these surgical techniques has paralleled the evolution of our understanding of cardiac arrhythmias and the availability of more sophisticated methods for their electrophysiologic evaluation. In some cases these arrhythmias can be treated by electrical devices such as antitachycardia pacemakers, internal cardioverters, or automatic internal defibrillators. The implantation of these devices represents a surgical procedure designed to terminate the arrhythmias once they have developed rather than to ablate arrhythmogenic substrates responsible for the arrhythmias. Therefore, this chapter will not address the role of these electrical devices in the management of cardiac arrhythmias but instead will be confined to a discussion of direct surgical techniques employed to either ablate or isolate arrhythmogenic myocardium in the atria and ventricles.