title: Hemodynamic assessment with interventional support should be routine for primary electrophysiology procedures after atrial switch procedure.
abstract: OBJECTIVE
  We sought to review our current philosophy that all primary invasive electrophysiologic (EP) studies in patients with atrial switch procedures (ASPs) should undergo hemodynamic evaluation and have interventional expertise available.
  
  
  BACKGROUND
  Patients who have undergone an ASP for dextro-transposition of the great arteries have a high incidence of both hemodynamic and EP sequelae. We present our data to support the combined assessment approach for these patients.
  
  
  METHODS
  Hemodynamic evaluation and interventions performed concurrently during a primary invasive EP procedure in patients with ASP were reviewed.
  
  
  RESULTS
  A total of 18 patients underwent concurrent EP invasive procedure and cardiac catheterization. The median age was 31 (14-43 years) with the majority being male (67%). Patients underwent a total of 30 concurrent primary invasive EP procedure and cardiac catheterization; 14 (47%) of the catheterization procedure were interventional. Some of the catheterization procedures required more than one intervention with total of 19 separate interventions. There were nine (47%) unexpected interventions. The majority of patients (n = 14, 77.8%) had one or more abnormal hemodynamic finding including baffle obstruction (n = 13, 72%), elevated filling pressures (n = 3, 17%), and secondary pulmonary hypertension (n = 3, 17%). Non-EP-related interventional procedures included systemic or pulmonary venous baffle stenting for significant obstruction (n = 7). EP-related interventions included transbaffle puncture for ablation of left-sided reentry circuits (n = 5), closure of previously undiagnosed baffle leaks prior to pacemaker/implantable cardioverter defibrillator (ICD) placement to prevent paradoxical embolism (n = 3), superior baffle stenting to facilitate pacemaker/ICD lead placement (n = 2), and retrieval of retained transvenous pacemaker/ICD lead (n = 2).
  
  
  CONCLUSIONS
  Due to the frequency of abnormal hemodynamics or interventional needs, strong consideration for routine concurrent hemodynamic assessment and availability of interventional expertise is warranted during primary invasive EP procedures in patients post ASP.
authors.affiliation: Stead Family Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA.
authors.forename: Osamah
authors.initials: O
authors.lastname: Aldoss
authors.forename: Nicholas
authors.initials: N
authors.lastname: Von Bergen
authors.forename: Ian
authors.initials: I
authors.lastname: Law
authors.forename: Abhay
authors.initials: A
authors.lastname: Divekar
mesh_terms: D000293:Adolescent; D000328:Adult; D000069278:Arterial Switch Operation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies; D055815:Young Adult
keywords: Atrial Switch Procedure; Concurrent Procedure; Percutaneous Intervention