Background: Patients with transposition of the great arteries (D-TGA) status post intra-atrial baffle repair have a high risk of sudden cardiac death. Little data exists on the use of implantable cardioverter-deffibrilators (ICDs) for primary prevention in this patient population. The aim of this study was to evaluate the incidence and causes of appropriate and inappropriate ICD shocks.
Methods: Retrospective analysis of all patients with D-TGA who underwent both atrial switch and ICD implantation for primary prevention.
Results: Eighteen patients (15 males, 83%) who fulfilled both criteria were identified. The average age at atrial switch was 2.5 years (0.1 – 17) and the average age at ICD implantation 26 years ( 15 - 41). Average follow up was 3.7 years (1 – 8.2). Systemic right ventricular function was moderate to severely depressed in 9 patients. Electrophysiologic studies were performed in 13 patients, of them 6 had nonsustained ventricular arrhythmias, 6 had sustained ventricular arrhythmias and 4 had combined atrial and ventricular arrhythmias. One patient (5%) received an appropriate shock, whereas 10 patients (55%) received inappropriate shocks: 5 for atrial flutter, 3 due to lead fracture and one each for T wave oversensing, supraventricular tachycardia and sinus tachycardia. Five patients (28%) required lead extraction: 3 for lead fractures, 1 for poor sensing and 1 for endocarditis. In addition, three patients required generator change due to device recalls.
Conclusions: Low incidence of appropriate shocks vs. high incidence of inappropriate shocks and complications were found in this cohort of patients with D-TGA who underwent atrial switch and primary-prevention ICDs placement . EP study results did not correlate with appropriate shock delivery. Algorithms to treat atrial flutter should be utilized in this population to avoid inappropriate shocks.
