Sudden Death and Defibrillators in Transposition of the Great Arteries With Intra-atrial Baffles: A Multicenter Study
Abstract
BACKGROUND: Transposition of the great arteries with intra-atrial baffle repair is among the congenital heart defects at highest risk of sudden death. Little is known about mechanisms of sudden death and the role of implantable cardioverter defibrillators. METHODS AND RESULTS: We conducted a multicenter cohort study in patients with transposition of the great arteries to determine actuarial rates of implantable cardioverter defibrillator shocks, identify risk factors, assess underlying arrhythmias, and characterize complications. Overall, 37 patients (age, 28.0+/-7.6 years; 89.2% male) were enrolled from 7 sites. Implantable cardioverter defibrillators were implanted for primary prevention in 23 (62.1%) patients and secondary prevention in 14 patients (37.8%). Annual rates of appropriate shocks were 0.5% and 6.0% in primary and secondary prevention, respectively (P=0.0366). Independent predictors were a secondary prevention indication (hazard ratio, 18.0; P=0.0341) and lack of beta-blockers (hazard ratio, 16.7; P=0.0301). In patients with appropriate shocks, intracardiac electrograms documented supraventricular tachycardia preceding or coexisting with ventricular tachycardia in 50%. No patient with inducible ventricular tachycardia received an appropriate shock in comparison with 37.5% of noninducible patients (P=0.0429). Inappropriate shocks occurred in 6.6% per year, more so in patients of lesser weight (hazard ratio, 0.91 per kg; P=0.0168). Additionally, 14 patients (37.8%) experienced complications: 5 (13.5%) acute, 1 (2.7%) late generator related, and 12 (32.4%) late lead related. CONCLUSIONS: In patients with transposition of the great arteries, high rates of appropriate shocks are noted in secondary but not primary prevention. Supraventricular arrhythmias may be implicated in the etiology of ventricular tachyarrhythmias; beta-blockers seem protective, and inducible ventricular tachycardia does not seem to predict future events. Inappropriate shocks and late lead-related complications are common.
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Independent predictors for appropriate ICD shocks in a multicentre cohort study of patients with TGA with intra-atrial baffle repair included lack of beta-blockers (HR 16.7; P=0.0301).
“Independent predictors for appropriate ICD shocks in multicentre cohort study of patients with transposition of the great arteries with intra-atrial baffle repair were, among others, lack of beta-blockers (hazard ratio, 16.7; P ¼ 0.0301).367”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [367]
Documented SVT preceded or coexisted with VT in 50% of patients with appropriate shocks.
“Documented SVT preceded or coexisted with VT in 50% of patients with appropriate shocks.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [367]
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- Authors
- Khairy, P., Harris, L., Landzberg, M. J., Fernandes, S. M., Barlow, A., Mercier, L.-A., Viswanathan, S., Chetaille, P., Gordon, E., Dore, A., & Cecchin, F.
- Affiliations
- Boston Children's Hospital (US)
- From the Canadian Adult Congenital Heart Network, Montreal, Quebec, Canada (P.K., L.H., A.B., L.A.M., P.C., E.G., A.D.); Leeds General Infirmary, Leeds, United Kingdom (S.V., P.C.); and Children’s Hospital, Boston, Mass (P.K., M.J.L., S.M.F., F.C.).
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2008-10
- Volume
- 1
- Issue
- 4
- Pages
- 250-257
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2150135622
- Cited by
- 269
- References
- 37
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 10 · 2023: 14 · 2022: 16 · 2021: 11 · 2020: 15 · 2019: 10 · 2018: 31 · 2017: 35 · 2016: 23 · 2015: 19 · 2014: 14 · 2013: 15 · 2012: 12
- FWCI
- 5.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centre International de Recherche sur le Cancer
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- transposition of the great arteries, sudden cardiac death, implantable cardioverter-defibrillator, appropriate shocks, inappropriate shocks, supraventricular tachycardia, ventricular tachycardia, beta-blockers, lead complications, primary and secondary prevention, congenital heart disease, arrhythmia mechanisms
- MeSH terms
- Adult, Canada, Female, Follow-Up Studies, Humans, Male, Prognosis, Retrospective Studies, Tachycardia, Transposition of Great Vessels, United States, Incidence, Death, Sudden, Cardiac, Defibrillators, Implantable
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