SURGERY FOR VENTRICULAR-TACHYCARDIA ASSOCIATED WITH RIGHT VENTRICULARDYSPLASIA - DISARTICULATION OF RIGHT VENTRICLE IN 9 OF 10 CASES

Ten patients (nine men, one woman; mean age 39 years) with arrhythmoge nic right ventricular dysplasia underwent surgery to control life-thre atening drug refractory ventricular arrhythmias. All had ventricular t achycardia causing syncope and six had a history of cardiac arrest. In all a minimum of three antiarrhythmic drugs (mean five) had been inef fective. At operation, the right ventricle was grossly diseased in all patients. Ventricular tachycardias were induced and mapped intraopera tively in all patients. The surgical plan was to ablate the arrhythmog enic focus if it was < 4 cm2; one patient was so managed. Of the remai ning nine, four underwent partial (approximately 40% of the right vent ricular free wall) and five underwent total right ventricular disartic ulation. All survived the operation and are alive at a mean follow-up interval of 24 months (range 5 to 67). Two patients developed new sust ained ventricular tachycardias. These were well tolerated and, unlike the original arrhythmias, were easily controlled by drug treatment. Al l patients who underwent right ventricular disarticulation manifested signs of right heart failure in the early postoperative period, but th ese lessened progressively with the development of systolic septal mov ement into the right ventricular cavity. All 10 patients are in New Yo rk Heart Association class I or II at last review. In selected patient s with arrhythmogenic right ventricular dysplasia, surgery offers a cu rative treatment for ventricular tachycardia and should be considered for patients whose arrhythmias are life-threatening and refractory to drug treatment.