This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Guiraudon, G. M. Articles by Ko, P. T. Search for Related Content PubMed PubMed Citation Articles by Guiraudon, G. M. Articles by Ko, P. T.

Circulation, Vol 67, 463-470, Copyright © 1983 by American Heart Association

ARTICLES

Total disconnection of the right ventricular free wall: surgical treatment of right ventricular tachycardia associated with right ventricular dysplasia

GM Guiraudon, GJ Klein, SS Gulamhusein, GA Painvin, C Del Campo, JC Gonzales and PT Ko

Arrhythmogenic right ventricular dysplasia is a myopathy that affects the right ventricular free wall (RVFW) and gives rise to recurrent reentrant ventricular tachycardia (VT). Because the entire right ventricle is potentially arrhythmogenic, ablating a single site of VT may not eliminate the arrhythmia. We developed an operation to confine any arrhythmic activity arising from the right ventricle to that chamber: total disconnection of the RVFW from the left ventricle. We performed RVFW disconnection in two patients with refractory VT associated with arrhythmogenic right ventricular dysplasia. At least two sites or origin of morphologically distinct VT were identified in the RVFW in each patient. RVFW disconnection was carried out under normothermic cardiopulmonary bypass. An encircling incision was made along the attachment of the RVFW to the aortoventricular unit and the tricuspid annulus; the right coronary artery and its RVFW branches were left intact. Electrical activity of the two chambers became dissociated, and VT arising from the RVFW was confined to that chamber. Postoperatively, there was no clinical evidence of hemodynamic impairment (follow-up 4 months and 3 months). Left ventricular function was unchanged and right ventricular flow was maintained by atrial contraction and motion of the septum toward the RVFW during left ventricular systole. One patient had incessant right ventricular tachycardia confined to the RVFW for 3 weeks. We conclude that RVFW disconnection is feasible and applicable to patients with refractory VT originating in the diffusely diseased RVFW.

This article has been cited by other articles:

				K. A. Michael and J. M. Morgan Not letting the left side know what the right is doing! Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 748 - 750. [Abstract] [Full Text] [PDF]

				Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]

				Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]

				J. Zacharias, J. Forty, J. C. Doig, J. P. Bourke, and C. J. Hilton Right ventricular disarticulation. An 18-year single centre experience Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1000 - 1004. [Abstract] [Full Text] [PDF]

				H. Miljoen, S. State, C. de Chillou, I. Magnin-Poull, P. Dotto, M. Andronache, A. Abdelaal, and E. Aliot Electroanatomic mapping characteristics of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia Europace, January 1, 2005; 7(6): 516 - 524. [Abstract] [Full Text] [PDF]

				P. Motta, E. Mossad, and R. Savage Right Ventricular Exclusion Surgery for Arrhythmogenic Right Ventricular Dysplasia with Cardiomyopathy Anesth. Analg., June 1, 2003; 96(6): 1598 - 1602. [Abstract] [Full Text] [PDF]

				N. Goldschlager, A. E. Epstein, B. P. Grubb, B. Olshansky, E. Prystowsky, W. C. Roberts, M. M. Scheinman, and for the Practice Guidelines Subcommittee, North Am Etiologic Considerations in the Patient With Syncope and an Apparently Normal Heart Arch Intern Med, January 27, 2003; 163(2): 151 - 162. [Full Text] [PDF]

				S. Sano, K. Ishino, M. Kawada, S. Kasahara, T. Kohmoto, M. Takeuchi, and S.-i. Ohtsuki Total right ventricular exclusion procedure: An operation for isolated congestive right ventricular failure J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 640 - 647. [Abstract] [Full Text] [PDF]

				N G Fisher and T J Gilbert Arrhythmogenic right ventricular dysplasia. An illustrated review highlighting developments in the diagnosis and management of this potentially fatal condition Postgrad. Med. J., July 1, 2000; 76(897): 395 - 398. [Abstract] [Full Text]