Abstract 13984: Arrhythmia in Patients With Corrected Transposition of the Great Arteries Before and After Double Switch Operation
Background: Patients with corrected transposition of the great arteries (cTGA) often develop arrhythmia. We evaluated arrhythmia in patients before and after the double switch operation (DSO).
Methods: We analyzed arrhythmia in 88 patients before DSO. The mean age at the time of operation was 6.9±4.4 years. Follow-up was available in 64 patients for a time period of 13±4 years after DSO.
Results: Before DSO, 15 of 88 patients (17%) had clinical tachycardia and/or a substrate for tachycardia. All 15 patients underwent electrophysiological study. Eleven patients had twin atrioventricular (AV) nodes. In five of the eleven cases, twin AV nodes had the property of only antegrade conduction. Six patients with AV reentrant tachycardia involving twin AV nodes and four patients with WPW syndrome underwent radiofrequency catheter ablation (RFCA). There were no complications or recurrences after RFCA. Two cases had congenital complete AV block and underwent permanent pacemaker implantation (PMI) before DSO. Sixteen of 64 patients (25%) had tachycardia after DSO. Fourteen cases had intra-atrial reentrant tachycardia (IART), the average duration from the DSO to the first IART was 5 years. In 12 patients with IART, it was adequately controlled with anti-arrhythmic drugs. Four cases underwent successful RFCA, 2 of the 4 required a trans-atrial septal approach, there was no recurrence after RFCA. Two cases developed ventricular tachycardia, one was treated medically and the other was given an implantable cardioverter defibrillator. Fourteen of 64 patients (22%) had bradycardia (complete AV block in 10 and sick sinus syndrome in 4), of which 11 underwent PMI. Seven of 10 cases with complete AV block underwent PMI soon after DSO, in three patients complete AV block progressed and PMI was performed from 10 to 13 years after DSO. Thirty-four of 64 patients (53%) had no arrhythmia, but a total of 42 patients needed medical, interventional, surgical or combined therapy for arrhythmia before and/or after DSO.
Conclusion: Patients with cTGA have a high incidence of arrhythmia both before and after DSO. Close observation of patients with DSO is essential.
- © 2010 by American Heart Association, Inc.