**7. Postoperative protocol**

Postoperatively, no antiarrhythmic drugs are given, except the standard medication with a beta-blocker. Before discharge, every patient is submitted to a final electrophysiological investigation with an aggressive stimulation protocol to induce an arrhythmia. The photocoa‐ gulation is only considered successful, if no ventricular arrhythmia can be induced including VT´s different from the initial one or even Vfib. Patients with any type of inducible arrhythmia get an ICD before being discharged.

## **8. Results**

Depending of course on the number of foci mapped and photocoagulated, the operative procedure is prolonged for about half an hour. The heart is not arrested during this time, so


that the arrhythmia surgery does not add to the ischemic time. In our hands, the risk of the procedure is not significantly increased. Table 2 shows the results of the initial 32 patients treated consecutively by our group at the University Hospitals Bonn and Marburg (17,20).

**Table 1.** Results of 32 patients treated consecutively because of VT and severe coronary artery disease

One has to keep in mind, that all patients being treated endo- and epicardially for their VT were primarily referred because of severe coronary artery disease and large ventriclar aneurysms, resulting in a severely reduced left ventricular function prior to surgery, so that the mortality is in accordance with the predicted mortality of this high risk group alone.

Among the group with sole epicardial photocoagualation, around 40% still had inducible VT ´s during the postoperative electrophysiological examination. Most of them were not identical with the initial clinical one. However, according to our protocol, they were registered as non successful and received an ICD. Still, 60 % of those formerly not curatively treatable patients could remain without ICD and among the remaining 40% with ICD´s, shocks could be avoided or kept very rare, so that this limited access approach is also worth while being persued.
