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.

Europace. 2015 Dec 23. pii: euv297. [Epub ahead of print]

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.

Buber J1Ackley TJ2Daniels CJ2Roble SL2Mah ML2Kamp AN2Kertesz NJ2.

Comment by A. ASami Chaouki

Abstract

In this study, Buber and colleagues investigated the incidence and causes of device shocks and complications among patients with d-TGA and intra-atrial baffle repair.  They reviewed 18 patients who had received an ICD (at average age at implantation of 26 years).  ICDs were placed for inducible sustained VT/VF, syncope (without SND), NSVT on Holter or exercise stress test, and severe RV dysfunction with QRS >/=140 msec.  Ten patients received shocks for non-ventricular arrhythmias and one received a shock for ventricular tachycardia.  This one patient received a shock 8 years after implant with moderate-severely reduced RV function, QRS 172 msec, NSVT on exercise testing  and EPS.  This patient’s VT was preceded by atrial flutter.  Among all patients, annual rates of shocks of 7.1% occurred.  Seven patients were shocked for SVTs, of which the majority was atrial flutter.  On multivariable analysis, the only differences between those who received a shock and those who did not were an elevated RVEDP (>/=10 mm Hg) and sinus node dysfunction.  Fifty percent of the patients had non-shock device complications including lead dislodgement, recall, undersensing, endocarditis, and lead fracture.  This study, in addition to the larger study by Khairy et al (Circ Arrhythm Electrophysiol 2008;1:250-7) continue to call into question our ability to determine who in this population is at risk for sudden cardiac death and questions the risk/benefits ratio for implantation of ICD in this population.  The authors suggest targeting better control of atrial tachyarrhythmias in this population.