title: Right ventricular disarticulation. An 18-year single centre experience.
abstract: OBJECTIVE
  Right ventricular disarticulation (RVD) is an accepted procedure in the treatment of ventricular tachycardia of right ventricular origin. We set out to review the long-term outcomes with RVD at our institution for patients with arrhythmogenic right ventricular dysplasia (ARVD) or refractory tachycardia. A renewed interest in this operation has come about in patients unable to tolerate implantable cardioverter defibrillators.
  
  
  METHODS
  Seventeen patients had RVD carried out between 1985 and 2003. There were 15 males and 2 females. The age range was 14-72 (median: 34). Six patients had partial RVD and 11 a complete RVD. ARVD was confirmed in 15 patients at histology. Biventricular pacing was used post-operatively in the two most recent patients.
  
  
  RESULTS
  The follow-up was complete in 94% (16/17). The median follow-up was 13 years (0-18). The overall hospital mortality was 6% (1/17). Over the follow-up period there were three deaths 9, 11 and 17 years post-surgery. Heart transplantation due to biventricular failure was required in two patients. In the group followed up for more than 10 years the over all event free survival at 10 years was 77% (3/13).
  
  
  CONCLUSIONS
  In cases of refractory ventricular tachycardia, where multiple antiarrhythmic medication, repeated catheter ablation and ICD insertion are unsuccessful at symptom control, RVD is an excellent antiarrhythmic procedure. In the long term, signs of biventricular failure present, possibly, dependent on the natural history of ARVD. The long-term effect of biventricular pacing on the disarticulated right ventricle is yet to be defined.
authors.affiliation: Department of Academic Cardiology, Freeman Hospital, Newcastle upon Tyne, NE 7 7DN, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zacharias
authors.forename: Jonathan
authors.initials: J
authors.lastname: Forty
authors.forename: James Colin
authors.initials: JC
authors.lastname: Doig
authors.forename: John Pius
authors.initials: JP
authors.lastname: Bourke
authors.forename: Colin John
authors.initials: CJ
authors.lastname: Hilton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000401:mortality / Q000601:surgery* / Q000628:therapy