Right ventricular disarticulation. An 18-year single centre experience.

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Right ventricular tachycardia (RVT) often originates from arrhythmogenic right ventricular dysplasia (ARVD).
• Right ventricular disarticulation (RVD) is a surgical option for RVT when other treatments fail.
• There is renewed interest in RVD for patients intolerant to implantable cardioverter defibrillators (ICDs).

Purpose of the Study:

• To review the long-term outcomes of RVD in patients with ARVD or refractory tachycardia.
• To evaluate RVD's efficacy and safety as an antiarrhythmic procedure.

Main Methods:

• A retrospective review of 17 patients who underwent RVD between 1985 and 2003.
• Patients had a median age of 34 years; 15 had ARVD confirmed histologically.
• Post-operative biventricular pacing was used in the two most recent patients.

Main Results:

• Median follow-up was 13 years, with 94% complete follow-up.
• Overall hospital mortality was 6%. Three late deaths occurred at 9, 11, and 17 years post-surgery.
• Ten-year event-free survival was 77% in patients followed for over 10 years; two patients required heart transplantation for biventricular failure.

Conclusions:

• RVD is an effective antiarrhythmic procedure for refractory ventricular tachycardia unresponsive to medical therapy, catheter ablation, or ICDs.
• Long-term biventricular failure may develop, potentially related to the natural history of ARVD.
• The long-term impact of biventricular pacing on the disarticulated right ventricle requires further investigation.