title: Outcomes following the implantation of cardioverter-defibrillator for primary prevention in transposition of the great arteries after intra-atrial baffle repair: a single-centre experience.
abstract: OBJECTIVE
  Patients with D-loop transposition of the great arteries (D-TGA) status post intra-atrial baffling are at an increased risk for sudden cardiac arrest. The benefit of primary implantable cardioverter-defibrillator (ICD) implantation in these patients is questionable due to high burden of adverse events. We aimed to evaluate the incidence and causes of all types of device shocks, as well as of device-related complications among patients with D-TGA implanted with ICDs for primary prevention.
  
  
  RESULTS
  Retrospective analysis of all patients with D-TGA who underwent atrial switch procedure and ICD implantation for primary prevention. Eighteen patients (83% males) were identified. Average age at atrial switch was 2.5 years (range 0.1-17) and at ICD implantation 26 years (15-41). During a median follow-up of 4 years, 10 patients (55%) received shocks for non-ventricular arrhythmic events, whereas 1 patient was shocked for ventricular tachycardia, for an annual rate of shock delivery of 7.1%. The most common cause for shock delivery was the occurrence of atrial arrhythmias, mostly in the form of atrial flutter. Elevated systemic ventricular end-diastolic pressures were found to be associated with an increased risk for inappropriate shocks. Five patients (28%) required lead extraction and three required generator change due to device recalls during follow-up.
  
  
  CONCLUSIONS
  Atrial arrhythmias were the most common cause for ICD shocks in a primary prevention population, while ventricular tachycardia was infrequent. The association between elevated end-diastolic pressures and the occurrence of arrhythmias demonstrates the close mechano-electrical relationship in D-TGA and may be an important predictor of arrhythmic events.
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, USA yonibuber@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Buber
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, USA.
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Ackley
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, USA.
authors.forename: Curt J
authors.initials: CJ
authors.lastname: Daniels
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Roble
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, USA.
authors.forename: May Ling
authors.initials: ML
authors.lastname: Mah
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, USA.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Kamp
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, USA.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Kertesz
mesh_terms: D000293:Adolescent; D000328:Adult; D001282:Atrial Flutter / Q000453:epidemiology*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011322:Primary Prevention; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology*; D014188:Transposition of Great Vessels / Q000150:complications* / Q000601:surgery; D055815:Young Adult
keywords: Implantable cardioverter-defibrillator; Sudden cardiac arrest; Transposition of the great arteries