Reply to Letter From Nair et al.—Anatomical Considerations for Cardiac Resynchronization Therapy in Transposition of the Great Arteries

Abstract

We thank Dr Nair et al. for their interest in our article and for identifying this unfortunate transcriptional error.1Nair K. Oechslin E. Singla M. Roche S.L. Feasibility of transvenous coronary sinus lead implantation in congenitally corrected transposition of the great arteries.Can J Cardiol. 2014; 30: 248.e11Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The term “CCTGA” (congenitally corrected transposition of the great arteries) in the sentence in question should be replaced by “D-transposition of the great arteries.” Indeed, in our experience, CCTGA is among the most common indications for transvenous cardiac resynchronization therapy in congenital heart disease, in part because of the fragility of the systemic right ventricle, the high incidence of atrioventricular block, and the susceptibility to subpulmonary ventricular pacing–induced dyssynchrony. We were, however, referring to patients with D-transposition of the great arteries and atrial switch procedures, in whom the coronary sinus is not only difficult to access but also associated with the subpulmonary morphologic left ventricle. For patients with such anatomy, we described a hybrid approach to cardiac resynchronization therapy that includes transvenous leads positioned in accessible chambers (ie, neo–right atrium and subpulmonary left ventricle) and an epicardial lead placed on the systemic right ventricle.2Khairy P. EP challenges in adult congenital heart disease.Heart Rhythm. 2008; 5: 1464-1472Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar This clarification highlights the importance of understanding patient anatomy, reviewing surgical and procedural notes, and careful planning before embarking on any intervention in this patient population.DisclosuresThe authors have no conflicts of interest to disclose. We thank Dr Nair et al. for their interest in our article and for identifying this unfortunate transcriptional error.1Nair K. Oechslin E. Singla M. Roche S.L. Feasibility of transvenous coronary sinus lead implantation in congenitally corrected transposition of the great arteries.Can J Cardiol. 2014; 30: 248.e11Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The term “CCTGA” (congenitally corrected transposition of the great arteries) in the sentence in question should be replaced by “D-transposition of the great arteries.” Indeed, in our experience, CCTGA is among the most common indications for transvenous cardiac resynchronization therapy in congenital heart disease, in part because of the fragility of the systemic right ventricle, the high incidence of atrioventricular block, and the susceptibility to subpulmonary ventricular pacing–induced dyssynchrony. We were, however, referring to patients with D-transposition of the great arteries and atrial switch procedures, in whom the coronary sinus is not only difficult to access but also associated with the subpulmonary morphologic left ventricle. For patients with such anatomy, we described a hybrid approach to cardiac resynchronization therapy that includes transvenous leads positioned in accessible chambers (ie, neo–right atrium and subpulmonary left ventricle) and an epicardial lead placed on the systemic right ventricle.2Khairy P. EP challenges in adult congenital heart disease.Heart Rhythm. 2008; 5: 1464-1472Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar This clarification highlights the importance of understanding patient anatomy, reviewing surgical and procedural notes, and careful planning before embarking on any intervention in this patient population. DisclosuresThe authors have no conflicts of interest to disclose. The authors have no conflicts of interest to disclose. Feasibility of Transvenous Coronary Sinus Lead Implantation in Congenitally Corrected Transposition of the Great ArteriesCanadian Journal of CardiologyVol. 30Issue 2PreviewWe read with interest the article titled, “Electrophysiologic Considerations in Congenital Heart Disease and Their Relationship to Heart Failure” by Escudero et al., in the July 2013 of the Canadian Journal of Cardiology.1 The review is comprehensive and has important educational value. Nonetheless, we feel it important to comment on what we believe is an erroneous statement relating to the role of cardiac resynchronization therapy (CRT) in patients with congenitally corrected transposition of the great arteries (CCTGA). Full-Text PDF