Surgical options for refractory ventricular tachycardia.

Ventricular tachycardia (VT) is most often treated with antiarrhythmic drug therapy. When standard drugs fail, percutaneous, endocardial ablation guided by electroanatomic mapping is usually curative. Occasionally, these options are either unsuccessful or are not feasible, and surgical ablation is required. Surgical ablation of VT employs electroanatomic mapping and a variety of ablation strategies and technologies. The specific approach (endocardial vs. epicardial, beating heart vs. arrested) and ablation device must be tailored to the patient's anatomy and presentation. We present three cases to illustrate the range of surgical options available for ablation of VT arising from different anatomic foci.