title: Can we predict sudden cardiac death in long-term survivors of atrial switch surgery for transposition of the great arteries?
abstract: OBJECTIVE
  This study aims to identify predictors of sudden cardiac death (SCD) in patients with transposition of the great arteries (TGA) who have undergone atrial baffle surgery with the Mustard or Senning operation.
  
  
  BACKGROUND
  Patients with TGA and previous atrial baffle surgery are known to be at increased risk of SCD. Despite this, indications for insertion of an implantable cardiac defibrillator for primary prevention have not been established.
  
  
  METHODS
  Eighty-nine patients with a diagnosis of TGA and previous Mustard or Senning repair were identified. Medical records were reviewed for SCD, aborted SCD, implantation of cardiac defibrillator (ICD), and use of cardiac medications. Clinically significant events (heart failure admissions, documented arrhythmias, and insertion of a pacemaker) were ascertained, and results of echocardiograms were explored.
  
  
  RESULTS
  There were five SCDs in our population, and five patients underwent a primary prevention ICD insertion, with no subsequent sustained ventricular arrhythmia or aborted SCD. Patients who suffered SCD had undergone surgery at an older age (median 53 months vs. 14 months) in a slightly earlier era (median year of operation 1971 vs. 1975). Atrial arrhythmias requiring treatment were documented in 100% of the SCD and in 29% of the no SCD patients.
  
  
  CONCLUSIONS
  Criteria for insertion of primary prevention implantable cardiac defibrillators postatrial baffle surgery remain to be established. In the SCD subgroup, surgery at an older age, earlier era of surgical repair, and history of atrial arrhythmia appear to convey an increased risk of sudden death.
authors.affiliation: Cardiology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Miriam
authors.initials: M
authors.lastname: Wheeler
authors.forename: Leeanne
authors.initials: L
authors.lastname: Grigg
authors.forename: Dominica
authors.initials: D
authors.lastname: Zentner
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011322:Primary Prevention / Q000295:instrumentation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Cardiac; Congenital Heart Disease; Death; Defibrillator; Implantable; Mustard Repair; Senning Repair; Sudden; Transposition of the Great Arteries