ICD Therapy after Atrial Switch Repair for d-Transposition of the Great Arteries—German Multicenter Experience

Abstract

Sudden cardiac death is the most common cause of late mortality after atrial switch repair for d-transposition of the great arteries. Experience with ICD therapy in these patients is limited. We conducted a multicenter cohort study to determine the current state of ICD therapy in atrial switch patients at adult congenital heart disease centers. Biometrical and clinical data as well as data on device implantation, programming, ICD discharges and complications of 33 patients from four centers were analyzed retrospectively. ICDs were implanted for primary/secondary prevention in 29 (88%) and 4 (12%) individuals, respectively. Median age at implantation was 27.5 years. 30 patients (91%) presented with NYHA ≤II at implantation. All patients with secondary prevention indication were classified as NYHA I. 21 (64%) individuals suffered from atrial reentrant tachycardia (ART). During median follow-up of 4.7 years, 5 appropriate ICD therapies were delivered in 2 (6%) patients with primary prevention indication. 12 inappropriate ICD discharges occurred in 8 patients (24%) due to ART (n = 6) or lead failure (n = 2). ICD related complications occurred in 9 patients (27%): lead dislodgment/failure in 7 patients, ICD infection in 2 (6%) patients. At implantation, heart failure as defined by NYHA classification was not advanced in the majority of patients. Appropriate discharges were only occasionally observed. Lead failure and ART were present in >20% of the patients and were frequent reasons for inappropriate ICD discharges. Facing these results, rigorous treatment of ART seems mandatory.