Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Heart failure wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
Cardiac surgery wikipedia , lookup
Heart arrhythmia wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Ventricular fibrillation wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Right ventricular disarticulation for arrythmogenic right ventricular dysplasia: an 18 year single centre experience. J Zacharias, J Forty, C Doig*, J Bourke*, CJ Hilton. Departments of academic cardiology and cardiac surgery, Freeman Hospital, Newcastle upon Tyne. England. ARVD • • • • • • A Type of cardiomyopathy Affects all age groups Presentation with syncope / sudden death Ventricular Tachycardia / Fibrillation Familial occurrence Structural changes in R V Myocardium Histology Treatment options with ARVD patients: • Antiarrhythmic medication • Percutaneous catheter ablation • Automatic internal cardiac defibrillators. (AICD) • Surgery Right Ventricular Disarticulation Described initially by Guiraudon Animal studies done by Guiraudon & Cox et al Medium term results from Cox and Hilton et al Few surgical reports lately Retrospective Case series: • Institution: Tertiary referral centre : Freeman hospital. • Time Frame: July 1985 - July 2003. • Patient Numbers: 17, age range (14 - 72), 15 M / 2 F • Surgeons: CJ Hilton (14) & J Forty (3) Pre Op Details: • Presentation: » Syncope: 12 » Intractable VT : 3 patients » Electrical storms (AICD): 2 • Management; » » » » » » Drugs: 17 (Range 3 - 8) EPS: 17 AICD: 2 Echo: 14 Angio; 14 CT Scan: 2 Preop Echo Of ARVD patient Operative details: • Complete: 10 • Partial: 7 • Full Cardiopulmonary Bypass • Cold Blood Cardioplegia • Induce VT in the disarticulated segment Gross Appearance Of ARVD Heart Completed RV Disarticulation Post operative events: immediate I Mortality : 1 (6%) multi-organ failure Overall complication rate: 64% (11/17) Reopening for bleeding: Renal failure: Tracheostomy: Derangement of liver function: Pleural effusions: 4 3 2 1 3 Post operative events: immediate II o Mean post -operative hospital stay : 17.6 days (range 9 - 35 days) o Electrophysiological studies : 16 o Medication at discharge: Anticoagulation: 4 Antiarrhythmic drugs: 2 Digoxin & Diuretics: 6 o Biventricular pacing : 2 Post operative events: medium term • Further VT episodes : 4 • Partial 3/7 • Complete 1/10 • Supraventricular Tachycardia: 10 Echo findings14 yrs post RV Disarticulation. Post operative Events: Long Term • Follow up : 94% (15/16) – 1 lost to follow up alive & well at 5 years. • Median 13 years (range 0 - 18) • Death: 3 ( 9,11, 17 years post op) • Transplantation: 2 ( 3, 8 yrs post op) • Awaiting transplantation: 2 ( 3, 14 yrs post op) Kaplan-Meier actuarial survival 100 16 15 14 13 80 12 11 Survival % 60 40 20 0 0 5 10 Survival in yea rs 15 20 Discussion points: • Natural history of ARVD • Affects young patients • Biventricular failure affects some • Heart transplantation • Prevention of sudden death • Can occur despite AICD • International registry details awaited • Long term effects of biventricular pacing Effects of Right ventricular pacing QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. Conclusions: • Excellent antiarrhythmic procedure • 77% event free survival at 10 years • Heart failure may be related to natural history of ARVD Consider as an option in young patients with ARVD who cannot be managed with medication or AICD