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We report on 33 patients (pts) with medically refractory ventricular tachycardia (VT) after myocardial infarction in whom electrophysiologically guided surgery was performed. In 18 pts the origin of the VT was identified preoperatively by endocardial catheter mapping. Intraoperative endocardial mapping was performed in 32 pts. The origin of the VT was detected in 24 pts, whereas in 8 pts the surgical procedure was guided by the results of intraoperative mapping during sinus rhythm. In one patient no intraoperative mapping was performed and surgery was guided only according to the results of endocardial catheter mapping. A deep endomyocardial incision was performed in 14 pts, whereas local endocardial resection was done in 19 pts. Six pts (18%) died postoperatively still being in the hospital, 27 pts (82%) were discharged. There were 4 late deaths during mean follow up period of 18 months. One patient had a spontaneous recurrence of VT. 8 pts remained on antiarrhythmic medication due to complex ventricular arrhythmias. We conclude that in case of medically refractory VT in coronary artery disease, surgical therapy becomes an acceptable alternative when guided by pre- and intraoperative electrophysiological mapping.