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Original Articles

Sudden Death and Defibrillators in Transposition of the Great Arteries With Intra-atrial Baffles

A Multicenter Study

Paul Khairy, MD, PhD; Louise Harris, MD; Michael J. Landzberg, MD; Susan M. Fernandes, MHP, PA-C; Amanda Barlow, MD; Lise-Andrée Mercier, MD; Sangeetha Viswanathan, MRCPCH; Philippe Chetaille, MD; Elaine Gordon, MD; Annie Dore, MD and Frank Cecchin, MD

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.).

Correspondence to Dr Paul Khairy, Adult Congenital Heart Center, Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec, Canada H1T 1C8. E-mail paul.khairy{at}umontreal.ca

Received February 26, 2008; accepted July 23, 2008.

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 β-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.

Conclusion— 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; β-blockers seem protective, and inducible ventricular tachycardia does not seem to predict future events. Inappropriate shocks and late lead-related complications are common.

Key Words: death, sudden • heart arrest • defibrillation • heart defects, congenital • tachyarrhythmias • transposition of great vessels

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Related Article

Sudden Death and Defibrillators in Transposition of the Great Arteries With Intra-atrial Baffles: A Multicenter Study

Paul Khairy, Louise Harris, Michael J. Landzberg, Susan M. Fernandes, Amanda Barlow, Lise-Andrée Mercier, Sangeetha Viswanathan, Philippe Chetaille, Elaine Gordon, Annie Dore, and Frank Cecchin
Circ Arrhythm Electrophysiol 2008 1: 250-257. [Abstract] [Full Text] [PDF]