title: Remote monitoring leads to early recognition and treatment of critical arrhythmias in adults after atrial switch operation for transposition of the great arteries.
abstract: BACKGROUND
  Adults with transposition of the great arteries (TGA) after atrial switch repair have an increased risk for arrhythmia and sudden cardiac death. We analyzed whether a remote monitoring (RM) system as part of an implantable cardiac device contributes to timely recognition and improved treatment of critical arrhythmias in these patients.
  
  
  RESULTS
  All consecutive TGA patients (n=11) requiring a pacemaker or cardiac resynchronization therapy with or without implantable cardioverter defibrillator between 2008 and 2011 were included. RM-detected arrhythmia, abnormality of device integrity and reaction time from event transmission until acknowledgement via email and clinical decision making were analyzed and compared to a control group (n=21). In 10 patients (91%) 17 arrhythmias were detected, 8 patients (80%) indicated no symptoms. In the RM group time interval from transmission to acknowledgement was 2.4 days (range, 0-4.5 days). Clinical decision-making was advanced by a mean of 77.5 days (range, 10-197 days) compared with conventional follow-up and identified adaption of anti-arrhythmic medication in 8, electrical cardioversion in 2, overdrive pacing in 1 and radiofrequency ablation in 2 patients. A coronary sinus lead fracture was identified in 1 patient followed by successful replacement.
  
  
  CONCLUSIONS
  RM enables early detection of tachyarrhythmia followed by optimization of medical treatment and potentially life-saving anti-tachycardic intervention in adults after atrial repair of TGA.
authors: University Children's Hospital, Department of Pediatric Cardiology, Grown-up Congenital Heart Disease Unit, Medical University Graz.
authors: Bert
authors: B
authors: Nagel
authors: Jan
authors: J
authors: Janousek
authors: Martin
authors: M
authors: Koestenberger
authors: Robert
authors: R
authors: Maier
authors: Werner
authors: W
authors: Sauseng
authors: Volker
authors: V
authors: Strenger
authors: Andreas
authors: A
authors: Gamillscheg
authors: Peter
authors: P
authors: Zartner
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D058998:Remote Sensing Technology / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000601:surgery*