Abstract 20647: Sudden Cardiac Death After Atrial Switch Repair for D-Transposition of the Great Arteries: A Systematic Review and Meta-Analysis
Introduction: Patients who underwent atrial switch repair with the Mustard or Senning procedure for D-transposition of the great arteries (D-TGA) in childhood are at risk of late sudden cardiac death (SCD). The existing literature in this area is heterogeneous, consisting of individual cohorts with considerable controversy as to the predictors of SCD in this population.
Methods: A systematic review and meta-analysis was performed of published and unpublished studies documenting long-term mortality of patients undergoing the Mustard or Senning procedure with a mean or median follow-up of at least 10 years. Data describing SCD was extracted. Multiple studies from the same center as well as studies describing patients with palliative atrial switch procedures were excluded.
Results: A total of 23 studies comprising 3803 patients met criteria. The median annual incidence of SCD was 0.22% (IQR 0.16-0.35), with SCD being the single most common cause of late mortality across cohorts. Using a random effects model, pooled odds ratios were calculated for risk factors thought to predispose to late SCD. A history of supraventricular tachyarrhythmia (SVT) was the only significant risk factor for SCD (OR 5.58, 95% CI 2.90-10.74, I2 0) after pooling all 11 studies that provided sufficient patient data to calculate odds ratios (Figure). Other expected risk factors, most notably right ventricular dysfunction (OR 0.69, 95% CI 0.27-1.77, I2 59%) were not predictive of SCD.
Conclusions: SCD is the most common cause of long-term mortality in D-TGA patients after atrial switch. In this meta-analysis, presence of SVT was predictive of SCD, while other risk factors including right ventricular dysfunction were not. Additional studies are required to assess whether aggressive management of SVT, including medications, ablation and even placement of implantable cardioverter-defibrillators can reduce SCD in this population.
Author Disclosures: P. Venkatesh: None. A.M. Maw: None. A.T. Evans: None. A.D. Patel: None. R.A. Pashun: None. K. Fujikura: None. I. Minhas: None. L.K. Kim: None. R.V. Swaminathan: None. D.N. Feldman: None. R.M. Minutello: None. G. Bergman: None. S.C. Wong: None. E. Bacha: None. H.S. Singh: None.
- © 2016 by American Heart Association, Inc.