title: 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.
  
  
  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.
authors.affiliation: Canadian Adult Congenital Heart Network, Montreal, Quebec, Canada. paul.khairy@umontreal.ca
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Louise
authors.initials: L
authors.lastname: Harris
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Landzberg
authors.forename: Susan M
authors.initials: SM
authors.lastname: Fernandes
authors.forename: Amanda
authors.initials: A
authors.lastname: Barlow
authors.forename: Lise-Andrée
authors.initials: LA
authors.lastname: Mercier
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Viswanathan
authors.forename: Philippe
authors.initials: P
authors.lastname: Chetaille
authors.forename: Elaine
authors.initials: E
authors.lastname: Gordon
authors.forename: Annie
authors.initials: A
authors.lastname: Dore
authors.forename: Frank
authors.initials: F
authors.lastname: Cecchin
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013610:Tachycardia / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D014188:Transposition of Great Vessels / Q000150:complications / Q000401:mortality / Q000628:therapy*; D014481:United States / Q000453:epidemiology