Outcomes following the implantation of cardioverter-defibrillator for primary prevention in transposition of the great arteries after intra-atrial baffle repair: a single-centre experience.
AIMS
Patients with D-loop transposition of the great arteries (D-TGA) status post intra-atrial baffling are at an increased risk for sudden cardiac arrest. The benefit of primary implantable cardioverter-defibrillator (ICD) implantation in these patients is questionable due to high burden of adverse events. We aimed to evaluate the incidence and causes of all types of device shocks, as well as of device-related complications among patients with D-TGA implanted with ICDs for primary prevention.


METHODS AND RESULTS
Retrospective analysis of all patients with D-TGA who underwent atrial switch procedure and ICD implantation for primary prevention. Eighteen patients (83% males) were identified. Average age at atrial switch was 2.5 years (range 0.1-17) and at ICD implantation 26 years (15-41). During a median follow-up of 4 years, 10 patients (55%) received shocks for non-ventricular arrhythmic events, whereas 1 patient was shocked for ventricular tachycardia, for an annual rate of shock delivery of 7.1%. The most common cause for shock delivery was the occurrence of atrial arrhythmias, mostly in the form of atrial flutter. Elevated systemic ventricular end-diastolic pressures were found to be associated with an increased risk for inappropriate shocks. Five patients (28%) required lead extraction and three required generator change due to device recalls during follow-up.


CONCLUSION
Atrial arrhythmias were the most common cause for ICD shocks in a primary prevention population, while ventricular tachycardia was infrequent. The association between elevated end-diastolic pressures and the occurrence of arrhythmias demonstrates the close mechano-electrical relationship in D-TGA and may be an important predictor of arrhythmic events.
['Buber|Jonathan|J|', 'Ackley|Tamara J|TJ|', 'Daniels|Curt J|CJ|', 'Roble|Sharon L|SL|', 'Mah|May Ling|ML|', 'Kamp|Anna N|AN|', 'Kertesz|Naomi J|NJ|']
D000293:Adolescent D000328:Adult D001282:Atrial Flutter D016757:Death, Sudden, Cardiac D017147:Defibrillators, Implantable D005260:Female D006325:Heart Atria D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D015999:Multivariate Analysis D011322:Primary Prevention D016016:Proportional Hazards Models D012189:Retrospective Studies D017180:Tachycardia, Ventricular D014188:Transposition of Great Vessels D055815:Young Adult
Transposition of the great arteries Sudden cardiac arrest Implantable cardioverter-defibrillator