Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries.
OBJECTIVE
To examine the prevalence of sustained ventricular tachycardia (VT) and sudden death (SD) in adults with atrial repair of transposition of the great arteries (TGA) and to determine associated risk factors.


RESULTS
In a single-centre review, we studied the outcome of 149 adults (mean age 28 +/- 7 years) who had undergone a Mustard operation for TGA. During a mean follow-up of 9 +/- 6 years, sustained VT and/or SD occurred in 9% (13/149) of the cohort. Sustained VT/SD was more likely to occur in patients with associated anatomic lesions [hazard ratio (HR) 4.9, 95% CI 1.5-16.0], with NYHA class >or=III (HR 9.8, 95% CI 3.0-31.6) and with an impaired subaortic right ventricular (RV) ejection fraction (EF) (HR 2.2, 95% CI 1.2-4.0 per 10% decrease in EF). There was an inverse correlation between the RV-EF and both age and QRS duration. Patients with a QRS duration >or=140 ms were at highest risk of sustained VT/SD (HR 13.6, 95% CI 2.9-63.4). Atrial tachyarrhythmia was detected in 66 (44%) patients, but was not a statistically significant predictor of sustained VT/SD in our adult population (HR 2.7, 95% CI 0.6-13.0).


CONCLUSIONS
Sustained VT/SD in adults after a Mustard operation for TGA are more common than previously described. Age, systemic ventricular function, and QRS duration are interrelated and are associated with VT/SD. A QRS duration >or=140 ms helps to identify the high risk patient.
Schwerzmann
Markus
M
Departement of Cardiology, Grown-up Congenital Heart Disease Program, University of Bern, Inselspital, Bern, Switzerland.
Salehian
Omid
O
Harris
Louise
L
Siu
Samuel C
SC
Williams
William G
WG
Webb
Gary D
GD
Colman
Jack M
JM
Redington
Andrew
A
Silversides
Candice K
CK
D000293:Adolescent; D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000401:mortality; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult