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Ho R, Patel N, Sakhuja R, Inglessis-Azuaje I, Mela T. Lead Extraction and Baffle Stenting in a Patient with Transposition of the Great Arteries. Card Electrophysiol Clin 2024; 16:139-142. [PMID: 38749632 DOI: 10.1016/j.ccep.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
This case report discusses a 42-year-old male with dextro-transposition of the great arteries (D-TGA) status post Mustard repair and sick sinus syndrome status post dual-chamber pacemaker implant, who developed symptomatic superior vena cava (SVC) baffle stenosis. He was treated with a combined pacemaker extraction and subsequent SVC baffle stenting. The case highlights the complexities of treating SVC baffle stenosis in the presence of cardiac implantable devices and demonstrates the efficacy of this combined approach. Furthermore, the authors delve into the intricacies of D-TGA, its surgical history, and the long-term complications associated with atrial switch procedures.
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Affiliation(s)
- Rady Ho
- Lehigh Valley Heart and Vascular Institute, 1250 South Cedar Crest Boulevard, Allentown, PA 18103, USA.
| | - Nilay Patel
- Corrigan Minehan Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Rahul Sakhuja
- Corrigan Minehan Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Ignacio Inglessis-Azuaje
- Corrigan Minehan Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Theofanie Mela
- Corrigan Minehan Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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2
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Albertini M, Santens B, Fusco F, Sarubbi B, Gallego P, Rodriguez-Puras MJ, Prokselj K, Kauling RM, Roos-Hesselink J, Labombarda F, Van De Bruaene A, Budts W, Waldmann V, Iserin L, Woudstra O, Bouma B, Ladouceur M. External Validation of a Risk Score Model for Predicting Major Clinical Events in Adults After Atrial Switch. J Am Heart Assoc 2024; 13:e032174. [PMID: 38686874 PMCID: PMC11179903 DOI: 10.1161/jaha.123.032174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND A risk model has been proposed to provide a patient individualized estimation of risk for major clinical events (heart failure events, ventricular arrhythmia, all-cause mortality) in patients with transposition of the great arteries and atrial switch surgery. We aimed to externally validate the model. METHODS AND RESULTS A retrospective, multicentric, longitudinal cohort of 417 patients with transposition of the great arteries (median age, 24 years at baseline [interquartile range, 18-30]; 63% men) independent of the model development and internal validation cohort was studied. The performance of the prediction model in predicting risk at 5 years was assessed, and additional predictors of major clinical events were evaluated separately in our cohort. Twenty-five patients (5.9%) met the major clinical events end point within 5 years. Model validation showed good discrimination between high and low 5-year risk patients (Harrell C index of 0.73 [95% CI, 0.65-0.81]) but tended to overestimate this risk (calibration slope of 0.20 [95% CI, 0.03-0.36]). In our population, the strongest independent predictors of major clinical events were a history of heart failure and at least mild impairment of the subpulmonary left ventricle function. CONCLUSIONS We reported the first external validation of a major clinical events risk model in a large cohort of adults with transposition of the great arteries. The model allows for distinguishing patients at low risk from those at intermediate to high risk. Previous episode of heart failure and subpulmonary left ventricle dysfunction appear to be key markers in the prognosis of patients. Further optimizing risk models are needed to individualize risk predictions in patients with transposition of the great arteries.
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Affiliation(s)
- Mathieu Albertini
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
| | - Beatrice Santens
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit AORN dei Colli-Monaldi Hospital Naples Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit AORN dei Colli-Monaldi Hospital Naples Italy
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit Hospital Universitario Virgin del Rocio Seville Spain
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Seville Spain
| | - Maria-Jose Rodriguez-Puras
- Adult Congenital Heart Disease Unit Hospital Universitario Virgin del Rocio Seville Spain
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Seville Spain
| | - Katja Prokselj
- Department of Cardiology University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Robert Martijn Kauling
- Department of Cardiology, Thoraxcenter, ErasmusMC University Medical Center Rotterdam Rotterdam the Netherlands
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Rotterdam the Netherlands
| | - Jolien Roos-Hesselink
- Department of Cardiology, Thoraxcenter, ErasmusMC University Medical Center Rotterdam Rotterdam the Netherlands
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Rotterdam the Netherlands
| | - Fabien Labombarda
- Department of Cardiology CHU de Caen Caen France
- UNICAEN UR PSIR 4650 Caen France
| | - Alexander Van De Bruaene
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Victor Waldmann
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
| | - Laurence Iserin
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
| | - Odilia Woudstra
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | - Berto Bouma
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | - Magalie Ladouceur
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
- Division of Cardiology University Hospital Geneva Geneva Switzerland
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3
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Dodeja AK, Upadhyay S. Arrhythmias in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:175-188. [PMID: 38462322 DOI: 10.1016/j.hfc.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure and arrhythmias represent 2 major causes of mortality and morbidity in adults with congenital heart disease. Arrhythmias and heart failure are interdependent, and one may exacerbate the other. Treatment of one also has a positive impact on the other. Management approaches need to be multifaceted, including pharmacotherapy, optimization of hemodynamic status with catheter-based or surgical interventions, and specific management of arrhythmia with device or catheter ablation therapy.
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Affiliation(s)
- Anudeep K Dodeja
- Division of Pediatric Cardiology, Department of Pediatrics, Connecticut Children's, University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106, USA
| | - Shailendra Upadhyay
- Department of Pediatric Cardiology, Connecticut Children's, University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106, USA.
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4
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Alonso-Gonzalez R, Agorrody G. Special Considerations for Mechanical Circulatory Support or Device Therapy in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:155-165. [PMID: 38462320 DOI: 10.1016/j.hfc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure has become the leading cause of mortality in adult congenital heart disease (ACHD) patients after the fifth decade of life. There is scanty evidence supporting the use of guideline-directed medical therapy in ACHD, especially in systemic right ventricle or single ventricle physiology. In complex patients, diagnosing heart failure and timely referral for advanced therapies are challenging. Mechanical circulatory support has been significantly developed over the past decade and has recently emerged as a feasible therapeutic option for these patients. This review summarizes current evidence of mechanical circulatory support in this population, its potential uses, and challenges.
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Affiliation(s)
- Rafael Alonso-Gonzalez
- Toronto ACHD Program, Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Avenue, 5N-525, Toronto, Ontario, M5G 2N2, Canada.
| | - Guillermo Agorrody
- Toronto ACHD Program, Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Avenue, 5N-525, Toronto, Ontario, M5G 2N2, Canada
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5
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Goldstein SA, Krasuski RA. Complex Congenital Heart Disease in the Adult. Annu Rev Med 2024; 75:493-512. [PMID: 38285514 DOI: 10.1146/annurev-med-050922-052324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Congenital heart disease (CHD), a heterogeneous group of structural abnormalities of the cardiovascular system, is the most frequent cause of severe birth defects. Related to improved pediatric outcomes, there are now more adults living with CHD, including complex lesions, than children. Adults with CHD are at high risk for complications related to their underlying anatomy and past surgical palliative interventions. Adults with CHD require close monitoring and proactive management strategies to improve outcomes.
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Affiliation(s)
- Sarah A Goldstein
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard A Krasuski
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA;
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6
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Ntiloudi D, Rammos S, Karakosta M, Kalesi A, Kasinos N, Giannakoulas G. Arrhythmias in Patients with Congenital Heart Disease: An Ongoing Morbidity. J Clin Med 2023; 12:7020. [PMID: 38002634 PMCID: PMC10672721 DOI: 10.3390/jcm12227020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
With the aging of congenital heart disease (CHD) patients, the burden of arrhythmias is expanding. Atrial arrhythmias, especially intra-atrial reentrant tachycardia and atrial fibrillation, are the most prevalent forms of arrhythmia. Managing comorbidities, such as obesity, using pharmacotherapy, including antiarrhythmics and anticoagulants, and ablation therapy has become the cornerstone of arrhythmia management. Ventricular tachycardias are also not rare; however, except for tetralogy of Fallot patients, recommendations for the use of implantable cardioverter defibrillators for primary prevention in other CHD patients are still not well established. Patients with CHD might also present with atrioventricular blockages because of their anatomy or following a surgical procedure. The scope of this article is to review the current knowledge and discuss the future directions regarding arrhythmia management in CHD patients.
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Affiliation(s)
- Despoina Ntiloudi
- Department of Cardiology, Tzaneio General Hospital of Piraeus, 185 36 Piraeus, Greece; (M.K.); (A.K.); (N.K.)
- Echocardiography Training Center of Tzaneio ‘D. Beldekos’, 185 36 Piraeus, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, “Onassis” Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Maria Karakosta
- Department of Cardiology, Tzaneio General Hospital of Piraeus, 185 36 Piraeus, Greece; (M.K.); (A.K.); (N.K.)
- Echocardiography Training Center of Tzaneio ‘D. Beldekos’, 185 36 Piraeus, Greece
| | - Alkistis Kalesi
- Department of Cardiology, Tzaneio General Hospital of Piraeus, 185 36 Piraeus, Greece; (M.K.); (A.K.); (N.K.)
- Echocardiography Training Center of Tzaneio ‘D. Beldekos’, 185 36 Piraeus, Greece
| | - Nearchos Kasinos
- Department of Cardiology, Tzaneio General Hospital of Piraeus, 185 36 Piraeus, Greece; (M.K.); (A.K.); (N.K.)
- Echocardiography Training Center of Tzaneio ‘D. Beldekos’, 185 36 Piraeus, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece;
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Bessière F, Waldmann V, Combes N, Metton O, Dib N, Mondésert B, O'Leary E, De Witt E, Carreon CK, Sanders SP, Moore JP, Triedman J, Khairy P. Ventricular Arrhythmias in Adults With Congenital Heart Disease, Part II: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1121-1130. [PMID: 37673513 DOI: 10.1016/j.jacc.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 09/08/2023]
Abstract
There are marked variations in the incidence of sudden cardiac death (SCD) and in the substrates for ventricular arrhythmias (VAs) across the gamut of congenital heart defects. In this 2-part review, patients with higher-risk forms of congenital heart disease (CHD) were conceptually categorized into those with discrete anatomic isthmuses for macro-reentrant ventricular tachycardia (VT) (Group A) and those with more diffuse or less well-defined substrates (Group B) that include patchy or extensive myocardial fibrosis. The latter category encompasses CHD lesions such as Ebstein anomaly, transposition of the great arteries with a systemic right ventricle (RV), and congenital aortic stenosis. For Group B patients, polymorphic VT and ventricular fibrillation account for a higher proportion of VA. The prognostic value of programmed ventricular stimulation is less well established, and catheter ablation plays a less prominent role. As cardiomyopathies evolve over time, pathophysiological mechanisms for VA among Groups A and B become increasingly blurred.
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Affiliation(s)
- Francis Bessière
- Electrophysiology Unit, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Pediatric and Congenital Heart Disease Medico-Surgical Unit, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, LabTau, INSERM, Lyon, France.
| | - Victor Waldmann
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Pediatric and Congenital Medico-Surgical Unit, Necker Hospital, Paris, France; Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris Cité, PARCC, INSERM, Paris, France
| | - Nicolas Combes
- Clinique Pasteur, Toulouse, France; Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Olivier Metton
- Pediatric and Congenital Heart Disease Medico-Surgical Unit, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Nabil Dib
- Division of Electrophysiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Blandine Mondésert
- Division of Electrophysiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Edward O'Leary
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth De Witt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chrystalle Katte Carreon
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen P Sanders
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - John Triedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Khairy
- Division of Electrophysiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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8
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Bevilacqua F, Pasqualin G, Ferrero P, Micheletti A, Negura DG, D'Aiello AF, Giamberti A, Chessa M. Overview of Long-Term Outcome in Adults with Systemic Right Ventricle and Transposition of the Great Arteries: A Review. Diagnostics (Basel) 2023; 13:2205. [PMID: 37443599 DOI: 10.3390/diagnostics13132205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally corrected transposition of the great arteries (ccTGA). Despite the life expectancy of these patients is significantly increased, the long-term prognosis remains suboptimal due to late complications such as heart failure, arrhythmias, and premature death. These patients, therefore, need a close follow-up to early identify predictive factors of adverse outcomes and to implement all preventive therapeutic strategies. This review analyzes the late complications of adult patients with an sRV and TGA and clarifies which are risk factors for adverse prognosis and which are the therapeutic strategies that improve the long-term outcomes. For prognostic purposes, it is necessary to monitor sRV size and function, the tricuspid valve regurgitation, the functional class, the occurrence of syncope, the QRS duration, N-terminal pro B-type natriuretic peptide levels, and the development of arrhythmias. Furthermore, pregnancy should be discouraged in women with risk factors. Tricuspid valve replacement/repair, biventricular pacing, and implantable cardioverter defibrillator are the most important therapeutic strategies that have been shown, when used correctly, to improve long-term outcomes.
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Affiliation(s)
- Francesca Bevilacqua
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Giulia Pasqualin
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Paolo Ferrero
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Angelo Micheletti
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Diana Gabriela Negura
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Angelo Fabio D'Aiello
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Alessandro Giamberti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
- Congenital Cardiac Surgery Unit, IRCCS-Policlinico San Donato, 20097 Milano, Italy
| | - Massimo Chessa
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
- Vita Salute San Raffaele University, 20132 Milano, Italy
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Bhende VV, Sharma TS, Subramaniam KG, Sharma AS, Kumar A, Patel PR, Panesar G, Soni KA, Dhami KB, Patel NP, Majmudar HP, Pathan SR. Mid-Term Outlook Following Modified Senning's Operation for the Correction of Transposition of the Great Arteries: A Case Series and Review of Literature. Cureus 2023; 15:e36770. [PMID: 37009369 PMCID: PMC10053561 DOI: 10.7759/cureus.36770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
At the time of writing, two patients who underwent modified Senning's operation (MSO) for the treatment of transposition of great arteries (TGAs) were followed up. At the time of surgery, the patients were three months and 15 years old, respectively. The duration of the follow-up was three years, during which there was a good prognosis, and hence no further invasive treatments were required. There was normal functioning of the right ventricle (RV) in both patients, with the exception of a minor baffle leak in the three-month-old patient. At the annual three-year follow-up, the tricuspid regurgitation (systemic atrioventricular valve) status was moderate in the three-year-old child and mild in the 18-year-old girl. Both patients maintained sinus rhythm and are assigned classification as New York Heart Association (NYHA) Classes I and II. This study aims to assess the midterm outlook after MSO in order to identify and manage future long-term complications. Our report shows a positive outcome in terms of survival and functional activities among children with d-TGA; however, there is a strong need for future research to evaluate the prognosis in the long term (LT) and to assess the functioning of RV.
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10
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Albertini L, Kawada S, Nair K, Harris L. Incidence and Clinical Predictors of Early and Late Complications of Implantable Cardioverter-Defibrillators in Adults With Congenital Heart Disease. Can J Cardiol 2023; 39:236-245. [PMID: 36565849 DOI: 10.1016/j.cjca.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The implantable cardioverter-defibrillator (ICD) has been proven to improve survival in adults with congenital heart disease (ACHD), but it is associated with a high rate of complications. We aimed to quantify the incidence of early (≤ 3 months; ECs) and late (> 3 months; LCs) complications in ACHD patients implanted with an ICD and to identify their clinical predictors. METHODS We retrospectively reviewed 207 patients who had ICD follow-up at Toronto General Hospital from 1996 to 2019. RESULTS The most common diagnoses were tetralogy of Fallot (32.4%), dextro-transposition of the great arteries (17.9%), and congenital corrected transposition of the great arteries (13%). No intraprocedural complications were observed. Median follow-up was 3.4 years (IQR 0.1-23). 24 patients (12%) developed EC (4 hematomas, 20 lead dislodgements). A total of 56 LCs occurred (46% lead failure, 21% infection, 11% prophylactic lead extraction, 9% neurologic pain, 9% erosion, 4% other) with an incidence rate of LCs of 18% per 5 person-years. Anatomic complexity (odds ratio 2.9; P = 0.02) and cardiac resynchronization therapy defibrillator implant (odds ratio 2.5; P = 0.04) were associated with ECs. Survival rates free from LCs were 92%, 86%, and 65%, respectively, after 1, 5, and 10 years. Presence of legacy leads (hazard ratio 2.9; P = 0.006) and subpulmonary ejection fraction (5% increase, hazard ratio 1.35; P = 0.031) were associated with LCs. CONCLUSIONS ACHD patients at risk of sudden cardiac death continue to benefit from newer device technology. However, these patients, particularly those with greater anatomic and device complexity, remain at increased risk of developing complications over their lifetime. Given the life expectancy of this population, careful consideration needs to be given when a device for primary prevention is being contemplated.
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Affiliation(s)
- Lisa Albertini
- Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Satoshi Kawada
- Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Krishnakumar Nair
- Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Louise Harris
- Toronto General Hospital, University Health Network Toronto, Ontario, Canada.
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11
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Management of Heart Failure With Arrhythmia in Adults With Congenital Heart Disease. J Am Coll Cardiol 2022; 80:2224-2238. [DOI: 10.1016/j.jacc.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022]
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12
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 866] [Impact Index Per Article: 433.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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13
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Sarubbi B, Palma M, Merola A, Fusco F, Correra A, Colonna D, Romeo E, Grimaldi N, Ciriello GD, Scognamiglio G, Russo MG. Wearable cardioverter-defibrillator (life-vest): A feasible bridging treatment in adult congenital heart disease. Indian Pacing Electrophysiol J 2022; 22:217-222. [PMID: 35777690 PMCID: PMC9463467 DOI: 10.1016/j.ipej.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Wearable cardioverter-defibrillators (WCDs) are currently used in patients at temporarily heightened risk for sudden cardiac death (SCD) who are temporarily unable to receive an implantable cardioverter-defibrillator (ICD). WCD can safely record and terminate life-threatening arrhythmias through a non-invasive electrode-based system. The current clinical indications for WCD use are varied and keep evolving as experience with this technology increases. METHODS We reviewed and explored the data behind indications for WCD use and discuss its usefulness in congenital heart disease (CHD) patients. RESULTS We considered 8 consecutive patients (mean age 35.25 years, range 18-51 years, average duration of WCD use 4 months, range 3-6 months) with complex CHD, in which a WCD was used between June 2018 and January 2022. No sustained ventricular arrhythmias requiring shocks were recorded in the observation period. No inappropriate shocks were recorded. All the patients showed a good compliance and a very high mean wear time per day (21.2 ± 1 h a day). Four patients implanted a permanent device (3 CRT-D, 1 ICD), three underwent cardiac surgery at the end of the WCD period and one is still on the waiting list for the operation. CONCLUSIONS Larger trial could confirm the possible conceivable benefit from an extended use of the WCD in certain populations with complex CHD as in our case series, especially in patients with life-treating ventricular arrhythmias waiting for surgery for residual cardiac defects or in the early phases following the surgical/hemodynamic interventions, patients with tachycardiomyopathy expected to improve after the arrhythmias are removed and patients awaiting implantation of an ICD at high risk due to active infection.
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Affiliation(s)
- Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy.
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | | | - Maria Giovanna Russo
- Paediatric Cardiology Unit, "L.Vanvitelli" University - Monaldi Hospital, Naples, Italy
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14
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Late outcome, therapy and systemic ventricular function in patients with a systemic right ventricle: data of the German National Register for Congenital Heart Defects. Cardiol Young 2022; 32:1235-1245. [PMID: 34658317 DOI: 10.1017/s1047951121003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adults with systemic right ventricle have a significant risk for long-term complications such as arrhythmias or heart failure. METHODS A nationwide retrospective study based on the German National Register for Congenital Heart Disease was performed. Patients with transposition of the great arteries after atrial switch operation or congenitally corrected TGA were included. RESULTS Two hundred and eight-five patients with transposition of the great arteries after atrial switch operation and 95 patients with congenitally corrected transposition of the great arteries were included (mean age 33 years). Systolic function of the systemic ventricle was moderately or severely reduced in 25.5 % after atrial switch operation and in 35.1% in patients with congenitally corrected transposition. Regurgitation of the systemic atrioventricular valve was present in 39.5% and 43.2% of the cases, respectively. A significant percentage of patients also had a history for supraventricular or ventricular arrhythmias. However, polypharmacy of cardiovascular drugs was rare (4.5%) and 38.5 % of the patients did not take any cardiovascular medication. The amount of cardiovascular drugs taken was associated with NYHA class as well as systemic right ventricular dysfunction. Patients with congenitally corrected transposition were more likely to receive pharmacological treatment than patients after atrial switch operation. CONCLUSION A significant portion of patients with systemic right ventricle suffer from a relevant systemic ventricular dysfunction, systemic atrioventricular valve regurgitation, and arrhythmias. Despite this, medication for heart failure treatment is not universally used in this cohort. This emphasises the need for randomised trials in patient with systemic right ventricle.
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15
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Jensen AS, Jørgensen TH, Christersson C, Nagy E, Sinisalo J, Furenäs E, Gjesdal O, Eriksson P, Vejlstrup N, Johansson B, Hlebowicz J, Greve G, Dellborg M, Skulstad H, Kvidal P, Jokinen E, Sairanen H, Thilén U, Søndergaard L. Cause‐Specific Mortality in Patients During Long‐Term Follow‐Up After Atrial Switch for Transposition of the Great Arteries. J Am Heart Assoc 2022; 11:e023921. [PMID: 35861834 PMCID: PMC9707826 DOI: 10.1161/jaha.121.023921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Little is known about the cause of death (CoD) in patients with transposition of the great arteries palliated with a Mustard or Senning procedure. The aim was to describe the CoD for patients with the Mustard and Senning procedure during short‐ (<10 years), mid‐ (10–20 years), and long‐term (>20 years) follow‐up after the operation.
Methods and Results
This is a retrospective, descriptive multicenter cohort study including all Nordic patients (Denmark, Finland, Norway, and Sweden) who underwent a Mustard or Senning procedure between 1967 and 2003. Patients who died within 30 days after the index operation were excluded. Among 968 patients with Mustard/Senning palliated transposition of the great arteries, 814 patients were eligible for the study, with a mean follow‐up of 33.6 years. The estimated risk of all‐cause mortality reached 36.0% after 43 years of follow‐up, and the risk of death was highest among male patients as compared with female patients (
P
=0.004). The most common CoD was sudden cardiac death (SCD), followed by heart failure/heart transplantation accounting for 29% and 27%, respectively. During short‐, mid‐, and long‐term follow‐up, there was a change in CoD with SCD accounting for 23.7%, 46.6%, and 19.0% (
P
=0.002) and heart failure/heart transplantation 18.6%, 22.4%, and 46.6% (
P
=0.0005), respectively.
Conclusions
Among patients corrected with Mustard or Senning transposition of the great arteries, the most common CoD is SCD followed by heart failure/heart transplantation. The CoD changes as the patients age, with SCD as the most common cause in adolescence and heart failure as the dominant cause in adulthood. Furthermore, the risk of all‐cause mortality, SCD, and death attributable to heart failure or heart transplantation was increased in men >10 years after the Mustard/Senning operation.
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Affiliation(s)
| | | | | | - Edit Nagy
- Department of Medicine, Heart and Vascular Theme, Karolinska University Hospital Karolinska Institutet Stockholm Sweden
| | - Juha Sinisalo
- Heart and Lung Center Helsinki University Central Hospital Helsinki Finland
- Helsinki University Helsinki Finland
| | - Eva Furenäs
- Department of Cardiology, Sahlgrenska Academy University of Göteborg Gothenburg Sweden
| | - Ola Gjesdal
- Department of Cardiology, Rikshospitalet Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Norway
| | - Peter Eriksson
- Department of Cardiology, Sahlgrenska Academy University of Göteborg Gothenburg Sweden
| | - Niels Vejlstrup
- Department of Cardiology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Bengt Johansson
- Department of Surgery and Perioperative Sciences Umeå University Umeå Sweden
| | | | - Gottfried Greve
- Department of Cardiology Haukeland University Hospital Bergen Norway
| | - Mikael Dellborg
- Department of Cardiology, Sahlgrenska Academy University of Göteborg Gothenburg Sweden
| | - Helge Skulstad
- Department of Cardiology, Rikshospitalet Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Norway
| | - Per Kvidal
- Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
| | - Eero Jokinen
- Heart and Lung Center Helsinki University Central Hospital Helsinki Finland
- Helsinki University Helsinki Finland
| | - Heikki Sairanen
- Heart and Lung Center Helsinki University Central Hospital Helsinki Finland
- Helsinki University Helsinki Finland
| | - Ulf Thilén
- Department of Cardiology Lund University Hospital Lund Sweden
| | - Lars Søndergaard
- Department of Cardiology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
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16
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Chiriac A, Cheema KP, Giardi D, Espinosa SM, Fitzgerald P, Perez-Downes JC, Umadat G, Hodge DO, Phillips SD, Madhavan M, Asirvatham SJ, McLeod CJ. Atrial Arrhythmia Ablation in Patients With D-Transposition of the Great Arteries and Atrial Switch. Circ Arrhythm Electrophysiol 2022; 15:e010546. [PMID: 35763440 DOI: 10.1161/circep.121.010546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with D-transposition of the great arteries and atrial switch have a high incidence of atrial arrhythmias. We sought to analyze the arrhythmia substrate, ablation strategies, and outcomes for catheter ablation in this population. METHODS An in-depth analysis of all clinical and procedural data in patients with D-transposition of the great arteries, atrial baffles, and atrial arrhythmia ablation was performed. RESULTS A cohort of 32 patients (72% male, mean age 38±7 years) underwent ablation for non-AV nodal reentrant tachycardia atrial arrhythmias, and 4 patients underwent AV nodal reentrant tachycardia ablation. Cavotricuspid isthmus flutter (CTI-flutter) was the most common arrhythmia, encountered in 75% of patients, followed by scar-related intraatrial reentrant tachycardia (non-CTI intraatrial reentrant tachycardia, 53%) and focal atrial tachycardia (focal atrial tachycardia, 6%). Among the 32 patients, 26 underwent 31 procedures at our institution. For patients with prior outside intervention, the index ablation at our institution revealed CTI-dependent flutter in 3/5 cases. However, redo ablation after an index ablation with demonstrated bidirectional CTI block revealed different/new arrhythmia substrates (80% non-CTI intraatrial reentrant tachycardia, 40% focal atrial tachycardia). Achieving bidirectional block across the CTI often required ablating on both sides of the baffle (retroaortic access, 81%; using a baffle leak, 11.5%; or transbaffle puncture, 7.7%). Combined approaches were necessary in 19% to reach the critical tissue. Acute procedural success was 81%, and recurrence was documented in 58% of patients. Despite recurrence, clinical arrhythmia burden was significantly reduced post-ablation (P<0.001), with rare episodes, amenable to antiarrhythmic therapy. Redo ablation was required in 5 (19%) patients and uncovered new arrhythmia substrates. AV nodal reentrant tachycardia ablation also required transbaffle approaches in 3/4 patients. CONCLUSIONS CTI-dependent flutter was the most common arrhythmia in patients with Dextro-Transposition of the Great Arteries and atrial switch. Transbaffle approaches were often necessary, and, provided that bidirectional CTI block was achieved at the index ablation, late recurrence was due to different arrhythmia mechanisms. Despite recurrence, ablation was associated with significant clinical improvement.
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Affiliation(s)
- Anca Chiriac
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Kamal P Cheema
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Davide Giardi
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Samantha M Espinosa
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Patrick Fitzgerald
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL. (P.F., G.U.)
| | - Julio C Perez-Downes
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Goyal Umadat
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL. (P.F., G.U.)
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL. (D.O.H.)
| | - Sabrina D Phillips
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M., S.J.A., C.J.M.)
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M., S.J.A., C.J.M.)
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M., S.J.A., C.J.M.)
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17
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Ladouceur M, Van De Bruaene A, Kauling R, Budts W, Roos-Hesselink J, Villagrá Albert S, Sanchez Perez I, Sarubbi B, Fusco F, Gallego P, Rodriguez-Puras MJ, Bouchardy J, Blanche C, Rutz T, Prokselj K, Labombarda F, Iserin L, Wong T, Gatzoulis MA. A new score for life-threatening ventricular arrhythmias and sudden cardiac death in adults with transposition of the great arteries and a systemic right ventricle. Eur Heart J 2022; 43:2685-2694. [PMID: 35673927 DOI: 10.1093/eurheartj/ehac288] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/18/2022] [Accepted: 05/18/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS To investigate the incidence of major adverse ventricular arrhythmias and related events (MAREs) and to develop a stratification tool predicting MAREs in adults with a systemic right ventricle (sRV). METHODS AND RESULTS In a multicentre approach, all adults (≥16 years old) with a sRV undergoing follow-up between 2000 and 2018 were identified. The incidence of MAREs, defined as sudden cardiac death, sustained ventricular tachycardia, and appropriate implantable cardioverter-defibrillator (ICD) therapy, was analysed. The association of MAREs with clinical, electrical, and echocardiographic parameters was evaluated. A total of 1184 patients (median age 27.1 years; interquartile range 19.9-34.9 years; 59% male; 70% with atrial switch repair for D-transposition of the great arteries) were included. The incidence of MAREs was 6.3 per 1000 patient-years. On multivariate analysis, age, history of heart failure, syncope, QRS duration, severe sRV dysfunction and at least moderate left ventricular outflow tract obstruction were retained in the final model with a C-index of 0.78 [95% confidence interval (CI) 0.72-0.83] and a calibration slope of 0.93 (95% CI 0.64-1.21). For every five ICDs implanted in patients with a 5-year MARE risk >10%, one patient may potentially be spared from a MARE. CONCLUSION Sudden cardiac death remains a devastating cause of death in a contemporary adult cohort with a sRV. A prediction model based on clinical, electrocardiographic, and echocardiographic parameters was devised to estimate MARE risk and to identify high-risk patients who may benefit from primary prevention ICD implantation.
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Affiliation(s)
- Magalie Ladouceur
- Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, APHP, Paris Cité University, Paris 75015, France.,Centre de Recherche Cardiovasculaire de Paris, INSERM U970, 20 rue Leblanc, Paris 75015, France
| | - Alexander Van De Bruaene
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, and Catholic University Leuven, Leuven, Belgium
| | - Robert Kauling
- Department of Cardiology, Thoraxcenter, ErasmusMC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, and Catholic University Leuven, Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Thoraxcenter, ErasmusMC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Maria-Jose Rodriguez-Puras
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Judith Bouchardy
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service de Cardiologie, Département de Médecine, Hôpitaux Universitaires de Genève, 1205 Genève, Switzerland
| | - Coralie Blanche
- Service de Cardiologie, Département de Médecine, Hôpitaux Universitaires de Genève, 1205 Genève, Switzerland
| | - Tobias Rutz
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katja Prokselj
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Fabien Labombarda
- Cardiology Department, CHU de Caen, Caen, France.,UNICAEN, EA 4650 Caen, France
| | - Laurence Iserin
- Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, APHP, Paris Cité University, Paris 75015, France.,Centre de Recherche Cardiovasculaire de Paris, INSERM U970, 20 rue Leblanc, Paris 75015, France
| | - Tom Wong
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College School of Medicine, London, UK
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18
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Alotaibi A, Alakhfash GA, Alakhfash A, Mahmoud T, Alakhfash AA, Al Qwaee A, Mesned A. The Value of Continuous Electrocardiographic Monitoring in Pediatric Cardiology: A Local Center Experience. Cureus 2022; 14:e25667. [PMID: 35812585 PMCID: PMC9256012 DOI: 10.7759/cureus.25667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives This study aims to evaluate the value of Holter monitoring in pediatric cases and look for the best predictor for abnormal Holter monitoring. Methodology All patients referred with cardiac symptoms associated or possibly related to abnormal cardiac rhythm from January 2019 to December 2020 were retrospectively reviewed. The demographic, clinical, 12-lead electrocardiography (ECG), echocardiography, and Holter monitoring results were reviewed. Multinomial logistic regression analysis was used to assess the correlation between gender, age, type of symptoms, ECG, and echo abnormalities, and Holter monitoring results were analyzed. Results During the study period, a total of 189 Holter monitoring was performed for 187 patients. The mean age at the performance of Holter monitoring was 88.6 ± 57 months. The female/male ratio was 1.5:1. The commonest indications for Holter monitoring were abnormal 12-lead ECG (30.7%), palpitations (30.7%), syncopal attacks (12.7%), and chest pain (6.9%). Patients with congenital heart disease (CHD) pre- or post-cardiac intervention constitute 9% of the total Holter monitoring cases. Apart from sinus arrhythmia, 12-lead ECG was abnormal in 57 (30%) patients, with premature atrial complexes (PACs) being the most common abnormality. Echocardiography was abnormal in 67 (35.4%) cases, with secundum atrial septal defect (ASD) (6.3%) and mitral valve prolapse (5.8%) being the commonest abnormalities. The Holter monitoring was completely normal in 89 (47.1%) cases. The commonest Holter abnormalities were PACs (12.7%), supraventricular tachycardia (SVT) (5.8%), and premature ventricular complexes (PVCs) (4.8%). There were 24 patients with SVT, and eight of them had normal Holter monitoring. One patient with SVT had ablation by the electrophysiologist. Using the multinomial logistic regression analysis, significantly abnormal 12-lead ECG, the presence of CHD, and abnormal echocardiography predict the presence of abnormal Holter results with a statistically significant p-value. Conclusion Most pediatric arrhythmias are benign. Holter monitoring provides reassurance for the patient and family. Abnormal Holter monitoring is more often observed in patients with paroxysmal or persistently abnormal 12-lead ECG with or without associated cardiac abnormalities or cardiac interventions. The yield of Holter monitoring is low in children referred because of chest pain, palpitations, or syncope with no other cardiac symptoms and with a structurally and functionally normal heart.
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19
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Adult Congenital Heart Disease (ACHD). REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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Nishimoto T, Nishii N, Asada S, Nakagawa K, Morita H, Ito H. Ablation for unmappable ventricular tachycardia in a patient with complete transposition of the great arteries who underwent Rastelli repair. J Cardiol Cases 2022; 25:218-224. [DOI: 10.1016/j.jccase.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/06/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
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21
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Lewis MJ, Van Dissel A, Kochav J, DiLorenzo MP, Ginns J, Zemer-Wassercug N, Groenink M, Mulder B, Rosenbaum M. Cardiac MRI predictors of adverse outcomes in adults with a systemic right ventricle. ESC Heart Fail 2022; 9:834-841. [PMID: 35048545 PMCID: PMC8934915 DOI: 10.1002/ehf2.13745] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
Aims Predicting risk in individuals with a systemic right ventricle (SRV) remains difficult. We assessed the value of cardiac MRI (CMR) for predicting death, heart transplantation (HT), or need for a ventricular assist device (VAD) in adults with D‐transposition of the great arteries (DTGA) post Mustard/Senning and in adults with congenitally corrected transposition of the great arteries (ccTGA) at two large academic centres. Methods and results Between December 1999 and November 2020, 158 adult patients with an SRV underwent CMR. Indexed right ventricular end‐diastolic volume (RVEDVI), indexed right ventricular end‐systolic volume (RVESVI), right ventricular ejection fraction (RVEF), and right ventricular mass (RV mass) were determined by a core laboratory. Receiver operating curves, area under the curve (AUC), and cut‐points maximizing sensitivity and specificity for the endpoint for each CMR parameter were calculated. Over a median of 8.5 years, 21 patients (13%) met a combined endpoint of HT referral, VAD, or death. Each CMR parameter was significantly associated with the endpoint in both cohorts. The AUCs for RVEDVI, RVESVI, RVEF, and RV mass to predict the endpoint were 0.93, 0.90, 0.73, and 0.84 for DTGA and 0.76, 0.74, 0.71, and 0.74 for ccTGA, respectively. Optimized cut‐points for RVEDVI were calculated for DTGA and ccTGA and were 132 and 126 mL/m2, respectively. RVEDVI cut‐points were simplified to 130 mL/m2 for survival analysis, which was significantly associated with survival in both cohorts. Conclusions Cardiac MRI parameters are associated with an increased risk of death, HT, or VAD in patients with an SRV and should be considered to facilitate risk stratification.
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Affiliation(s)
- Matthew J Lewis
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, NY, USA
| | - Alexandra Van Dissel
- Division of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jonathan Kochav
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, NY, USA
| | - Michael P DiLorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Noa Zemer-Wassercug
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, NY, USA
| | - Maarten Groenink
- Division of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Barbara Mulder
- Division of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, NY, USA
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22
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23
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Baffle Complications in Adults After Atrial Switch for Transposition of the Great Arteries. Can J Cardiol 2021; 38:68-76. [PMID: 34634378 DOI: 10.1016/j.cjca.2021.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Baffle complications, ie, leakage or stenosis, after an atrial switch operation (AtrSO) for transposition of the great arteries (TGA) are difficult to detect with the use of routine transthoracic echocardiography (TTE). We examined baffle interventions and the prevalence of baffle complications. METHODS This dual-centre study followed TGA-AtrSO patients for the occurrence of baffle interventions. In addition, in 2017-2019, prevalence of baffle complications was determined in patients undergoing routine contrast-enhanced (CE) TTE including various hemodynamic conditions and computed tomography (CT). Baffle leaks were defined as right-to-left shunting on CE-TTE and baffle stenosis as a systemic venous baffle diameter of < 10 mm on CT. RESULTS In total, 67 TGA-AtrSO patients were followed to a median age of 38 (interquartile range 34-42) years, for a median of 9 (6-13) years. Baffle interventions were documented in 24 patients (36%). Cumulative risk of baffle interventions was 25% after 15 years of follow-up. Prevalence of baffle complications was determined in 29/67 patients. In total, 4 (14%) had patent baffles, 11 (38%) had leakage only, 5 (17%) had stenosis only, and 9 (31%) had both, while 24/29 (84%) were asymptomatic. Although baffle leaks were not associated with clinical characteristics, peak work rate during exercise TTE was lower in patients with vs without stenosis (89 ± 24 W vs 123 ± 21 W; P < 0.001). CONCLUSIONS Baffle complications are common in TGA-AtrSO. The cumulative risk of baffle interventions was 25% after 15 years of follow-up. CE-TTE uncovered asymptomatic baffle leakage in the majority of patients, especially with examination during exercise. CT revealed baffle stenosis in almost half of the patients, which was associated with decreased exercise tolerance. Awareness of these findings may alter clinical follow-up.
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Patel AH, Glovaci D, Donaldson D, McCanta AC. Electrophysiologic Management and Considerations for D-transposition of the Great Arteries After Atrial Baffle Repair. J Innov Card Rhythm Manag 2021; 12:4649-4656. [PMID: 34476118 PMCID: PMC8384306 DOI: 10.19102/icrm.2021.120805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022] Open
Abstract
This unique case highlights the electrophysiologic management and risk assessment of sudden cardiac death in a 35-year-old woman with a history of D-transposition of the great arteries status post–Mustard atrial switch repair.
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Affiliation(s)
- Akash H Patel
- Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
| | - Diana Glovaci
- Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA.,Department of Cardiology, University of California Irvine Medical Center, Riverside, CA, USA
| | - David Donaldson
- Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA.,Department of Cardiology, University of California Irvine Medical Center, Riverside, CA, USA.,Department of Clinical Electrophysiology, University of California Irvine Medical Center, Orange, CA, USA
| | - Anthony C McCanta
- Department of Clinical Electrophysiology, Children's Hospital of Orange County, Orange, CA, USA
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25
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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26
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Nederend M, Zandstra TE, Kiès P, Jongbloed MRM, Vliegen HW, Treskes RW, Schalij MJ, Atsma DE, Egorova AD. Potential of eHealth smart technology in optimization and monitoring of heart failure treatment in adults with systemic right ventricular failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:215-223. [PMID: 36712397 PMCID: PMC9707956 DOI: 10.1093/ehjdh/ztab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 02/01/2023]
Abstract
Aims Patients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA are prone to heart failure and arrhythmias. This study evaluated feasibility, patient adherence, and satisfaction of a smart technology-based care pathway for heart failure treatment optimization in these patients. Methods and results Patients with symptomatic sRV failure eligible for initiation of sacubitril/valsartan were provided with four smartphone compatible devices (blood pressure monitor, weight scale, step counter, and rhythm monitor) and were managed according to a smart technology-based care pathway. Biweekly sacubitril/valsartan titration visits were replaced by electronical visits, patients were advised to continue measurements at least weekly after titration. Data of 24 consecutive sRV patients (median age 47 years, 50% female) who participated in the smart technology-based care pathway were analysed. Median home-hospital distance was 65 km (maximum 227 km). Most patients (20, 83.3%) submitted weekly measurements; 100% submitted prior to electronical visits. Titration conventionally occurs during a hospital visit. By implementing eHealth smart technology, 68 such trips to hospital were replaced by virtual visits facilitated by remote monitoring. An eHealth questionnaire was completed by 22 patients (92%), and 96% expressed satisfaction. After titration, 30 instances of remote adjustment of heart failure medication in addition to scheduled outpatient clinic visits occurred, one (4%) heart failure admission followed, despite ambulant adjustments. Five patients (21%) sent in rhythm registrations (n = 17), of these 77% showed sinus rhythm, whereas supraventricular tachycardia was detected in the remaining four registrations. Conclusion These data suggest that implementation of a smart technology-based care pathway for optimization of medical treatment sRV failure is feasible with high measurement adherence and patient satisfaction.
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Affiliation(s)
- Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Tjitske E Zandstra
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Martin J Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- National eHealth Living Lab, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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27
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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28
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Mulder BJ, de Groot JR. ICD implantation as primary prevention in systemic RV? A cautious attitude is justified. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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29
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Sarubbi B, Correra A, Colonna D, Romeo E, Palma M, Merola A, D'Alto M, Scognamiglio G, Fusco F, Barracano R, Borrelli N, Grimaldi N, D'Onofrio A, Russo MG. Subcutaneous implantable cardioverter defibrillator in complex adult congenital heart disease. Results from the S-ICD “Monaldi Care” registry. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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Follow up after atrial switch surgery in patients with transposition of the great arteries; reality versus guidelines. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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31
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Köbe J, Willy K, Eckardt L, Baumgartner H, Wasmer K. Narrative review of: risk stratification and implantable cardioverter-defibrillator therapy in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:538-549. [PMID: 33968632 DOI: 10.21037/cdt-20-633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fortunately, the population of adults with congenital heart disease (ACHD) is growing due to improved operation techniques. Life expectancy is continuously rising, nevertheless, sudden cardiac death is one of the leading causes of mortality in ACHD late after initial diagnosis. Risk stratification in ACHD remains challenging as large study results are missing, congenital defects and operation methods differ considerably between individual patients and results from acquired heart diseases are often not conferrable. The purpose of this narrative review is to objectively summarize the current knowledge on arrhythmogenic risk of ACHD and to give an overview on implantable cardioverter-defibrillator (ICD) therapy in this collective. Remarkable progress has been made in electrophysiological understanding of critical areas of slow conduction especially in patients with Tetralogy of Fallot (ToF). In patients with transposition of the great arteries after atrial baffling (Mustard/Senning procedure) atrial arrhythmias play a crucial role in sudden cardiac death. ICD therapy in ACHD may pose special technical challenges due to limited access for intracardiac leads. The introduction of the totally subcutaneous ICD improved therapeutic options for ACHD especially when contraindications for transvenous leads are present. Risk stratification in ACHD has to be seen as a team approach, requires thorough understanding of congenital heart defects and the operation techniques and needs unconventional technical approaches in some cases.
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Affiliation(s)
- Julia Köbe
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Kevin Willy
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Kristina Wasmer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
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32
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Waldmann V, Combes N, Ladouceur M, Celermajer DS, Iserin L, Gatzoulis MA, Khairy P, Marijon E. Understanding Electrocardiography in Adult Patients With Congenital Heart Disease. JAMA Cardiol 2020; 5:1435-1444. [DOI: 10.1001/jamacardio.2020.3416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Victor Waldmann
- Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
- Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Nicolas Combes
- Pasteur Clinic, Toulouse, France
- Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Laurence Iserin
- Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Paul Khairy
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eloi Marijon
- Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
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33
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Oliver JM, Gallego P, Gonzalez AE, Avila P, Alonso A, Garcia-Hamilton D, Peinado R, Dos-Subirà L, Pijuan-Domenech A, Rueda J, Rodriguez-Puras MJ, Garcia-Orta R, Martínez-Quintana E, Datino T, Fernandez-Aviles F, Bermejo J. Predicting sudden cardiac death in adults with congenital heart disease. Heart 2020; 107:67-75. [PMID: 32546506 DOI: 10.1136/heartjnl-2020-316791] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual's characteristics, to guide primary prevention strategies. METHODS We combined data from a single-centre cohort of 3311 consecutive ACHD patients (50% male) at 25-year follow-up with 71 events (53 SCD and 18 non-fatal SCA) and a multicentre case-control group with 207 cases (110 SCD and 97 non-fatal SCA) and 2287 consecutive controls (50% males). Cumulative incidences of events up to 20 years for specific lesions were determined in the prospective cohort. Risk model and its 5-year risk predictions were derived by logistic regression modelling, using separate development (18 centres: 144 cases and 1501 controls) and validation (two centres: 63 cases and 786 controls) datasets. RESULTS According to the combined SCD/SCA cumulative 20 years incidence, a lesion-specific stratification into four clusters-very-low (<1%), low (1%-4%), moderate (4%-12%) and high (>12%)-was built. Multivariable predictors were lesion-specific cluster, young age, male sex, unexplained syncope, ischaemic heart disease, non-life threatening ventricular arrhythmias, QRS duration and ventricular systolic dysfunction or hypertrophy. The model very accurately discriminated (C-index 0.91; 95% CI 0.88 to 0.94) and calibrated (p=0.3 for observed vs expected proportions) in the validation dataset. Compared with current guidelines approach, sensitivity increases 29% with less than 1% change in specificity. CONCLUSIONS Predicting the risk of SCD/SCA in ACHD can be significantly improved using a baseline lesion-specific stratification and simple clinical variables.
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Affiliation(s)
- Jose M Oliver
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain.,Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Ana Elvira Gonzalez
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Pablo Avila
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Andres Alonso
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Diego Garcia-Hamilton
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Rafael Peinado
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Dos-Subirà
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Department of Cardiology, Vall d'Hebron University Hospital and CIBERCV, Barcelona, Spain
| | - Antonia Pijuan-Domenech
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Department of Cardiology, Vall d'Hebron University Hospital and CIBERCV, Barcelona, Spain
| | - Joaquín Rueda
- Adult congenital heart disease unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Maria-Jose Rodriguez-Puras
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Rocio Garcia-Orta
- Adult Congenital Heart Disease Unit, , Hospitales Virgen de las Nieves y Clínico San Cecilio, Granada, Spain
| | - Efrén Martínez-Quintana
- Adult Congenital Heart Disease Unit, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Tomas Datino
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Francisco Fernandez-Aviles
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Javier Bermejo
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
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34
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Barracano R, Brida M, Guarguagli S, Palmieri R, Diller GP, Gatzoulis MA, Wong T. Implantable cardiac electronic device therapy for patients with a systemic right ventricle. Heart 2020; 106:1052-1058. [PMID: 32269130 DOI: 10.1136/heartjnl-2019-316202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 11/04/2022] Open
Abstract
The systemic right ventricle (SRV), defined as the morphological right ventricle supporting the systemic circulation, is relatively common in congenital heart disease (CHD). Our review aimed at examining the current evidence, knowledge gaps and technical considerations regarding implantable cardiac electronic device therapy in patients with SRV. The risk of sinus node dysfunction (SND) after atrial switch repair and/or complete heart block in congenitally corrected transposition of great arteries requiring permanent pacing increases with age. Similar to acquired heart disease, indication for pacing includes symptomatic bradycardia, SND and high degree atrioventricular nodal block. Right ventricular dysfunction and heart failure also represent important complications in SRV patients. Cardiac resynchronisation therapy (CRT) has been proposed to improve systolic function in SRV patients, although indications for CRT are not well defined and its potential benefit remains uncertain. Amongst adult CHD, patients with SRV are at the highest risk for sudden cardiac death (SCD). Nevertheless, risk stratification for SCD is scarce in this cohort and implantable cardioverter-defibrillator indication is currently limited to secondary prevention. Vascular access and the incidence of device-related complications, such as infections, inappropriate shocks and device system failure, represent additional challenges to implantable cardiac electronic device therapy in patients with SRV. A multidisciplinary approach with tertiary expertise and future collaborative research are all paramount to further the care for this challenging nonetheless ever increasing cohort of patients.
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Affiliation(s)
- Rosaria Barracano
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Silvia Guarguagli
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
| | - Rosalinda Palmieri
- Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tom Wong
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
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35
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Sakhi R, Kauling RM, Theuns DA, Szili-Torok T, Bhagwandien RE, van den Bosch AE, Cuypers JAAE, Roos-Hesselink JW, Yap SC. Early detection of ventricular arrhythmias in adults with congenital heart disease using an insertable cardiac monitor (EDVA-CHD study). Int J Cardiol 2020; 305:63-69. [PMID: 32057477 DOI: 10.1016/j.ijcard.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/27/2019] [Accepted: 02/03/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) due to ventricular arrhythmias (VA) is an important mode of death in adults with congenital heart disease (CHD). Risk stratification is difficult in this heterogeneous population. Insertable cardiac monitors (ICM) may be useful for risk stratification. The purpose of the present study was to evaluate the use of ICM for the detection of VA in adults with CHD. METHODS In this prospective single-center observational study we included consecutive adults with CHD deemed at risk of VA who received an ICM between March 2013 and February 2019. The decision to implant an ICM was made in a Heart Team consisting of a cardiac electrophysiologist and a cardiologist specialized in CHD. RESULTS A total of 30 patients (mean age, 38 ± 15 years; 50% male) received an ICM. During a median follow-up of 16 months, 8 patients (27%) had documented nonsustained VA. Of these 8 patients, 3 (10%) received a prophylactic ICD. Furthermore, ICM-detected arrhythmias were present in 22 patients (73%) leading to a change in clinical management in 16 patients (53%). Besides the patients receiving an ICD, 10 patients (33%) had a change in their antiarrhythmic drugs, 6 patients (20%) underwent an electrophysiology study, and 1 patient (3%) received a pacemaker. CONCLUSIONS The detection of VA by the ICM contributed to the clinical decision to implant a prophylactic ICD. Furthermore, ICM-detected arrhythmias led to important changes in the clinical management. Therefore, long-term arrhythmia monitoring by an ICM seems valuable for risk stratification in adults with CHD.
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Affiliation(s)
- Rafi Sakhi
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
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Chubb H, Motonaga KS. Cardiac resynchronization and implantable defibrillators in adults with congenital heart disease. Heart Fail Rev 2019; 25:657-670. [PMID: 31754907 DOI: 10.1007/s10741-019-09886-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) are well-established therapies for adult patients with heart failure that have been shown to improve morbidity and mortality. However, the benefits and indications for use in adults with congenital heart disease (ACHD) are less defined with no significant large prospective studies in this population. There are, however, multiple retrospective studies that demonstrate the efficacy of these devices in the ACHD population. These indicate a role for both CRT and ICDs in select patients with ACHD. The clinician and patient must balance the risks and benefits, summarized in complex evidence that reflects the heterogeneity of the ACHD patient group, and apply them in a patient-specific manner to optimize the utility of CRT and ICDs.
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Affiliation(s)
- Henry Chubb
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA. .,Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, USA. .,Heart Center Research Core, Stanford University, 780 Welch Road, Palo Alto, CA, 94304-5701, USA.
| | - Kara S Motonaga
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
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Venkatesh P, Evans AT, Maw AM, Pashun RA, Patel A, Kim L, Feldman D, Minutello R, Wong SC, Stribling JC, LaPar D, Holzer R, Ginns J, Bacha E, Singh HS. Predictors of Late Mortality in D-Transposition of the Great Arteries After Atrial Switch Repair: Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012932. [PMID: 31642369 PMCID: PMC6898856 DOI: 10.1161/jaha.119.012932] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Existing data on predictors of late mortality and prevention of sudden cardiac death after atrial switch repair surgery for D‐transposition of the great arteries (D‐TGA) are heterogeneous and limited by statistical power. Methods and Results We conducted a systematic review and meta‐analysis of 29 observational studies, comprising 5035 patients, that reported mortality after atrial switch repair with a minimum follow‐up of 10 years. We also examined 4 additional studies comprising 105 patients who reported rates of implantable cardioverter‐defibrillator therapy in this population. Average survival dropped to 65% at 40 years after atrial switch repair, with sudden cardiac death accounting for 45% of all reported deaths. Mortality was significantly lower in cohorts that were more recent and operated on younger patients. Patient‐level risk factors for late mortality were history of supraventricular tachycardia (odds ratio [OR] 3.8, 95% CI 1.4–10.7), Mustard procedure compared with Senning (OR 2.9, 95% CI 1.9–4.5) and complex D‐TGA compared with simple D‐TGA (OR 4.4, 95% CI 2.2–8.8). Significant risk factors for sudden cardiac death were history of supraventricular tachycardia (OR 4.7, 95% CI 2.2–9.8), Mustard procedure (OR 2.2, 95% CI 1.1–4.1), and complex D‐TGA (OR 5.7, 95% CI 1.8–18.0). Out of a total 124 implantable cardioverter‐defibrillator discharges over 330 patient‐years in patients with implantable cardioverter‐defibrillators for primary prevention, only 8% were appropriate. Conclusions Patient‐level risk of both mortality and sudden cardiac death after atrial switch repair are significantly increased by history of supraventricular tachycardia, Mustard procedure, and complex D‐TGA. This knowledge may help refine current selection practices for primary prevention implantable cardioverter‐defibrillator implantation, given disproportionately high rates of inappropriate discharges.
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Affiliation(s)
- Prashanth Venkatesh
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Arthur T Evans
- Division of Hospital Medicine Weill Cornell Medicine New York Presbyterian Hospital New York NY
| | - Anna M Maw
- Division of Hospital Medicine Weill Cornell Medicine New York Presbyterian Hospital New York NY
| | - Raymond A Pashun
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Agam Patel
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Luke Kim
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Dmitriy Feldman
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Robert Minutello
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - S Chiu Wong
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Judy C Stribling
- Weill Cornell Medicine Samuel J. Wood Library Myra Mahon Patient Resource Center New York NY
| | - Damian LaPar
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Ralf Holzer
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Jonathan Ginns
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Emile Bacha
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Harsimran S Singh
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
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Salavitabar A, Bradley EA, Chisolm JL, Hickey J, Boe BA, Armstrong AK, Daniels CJ, Berman DP. Implantable pulmonary artery pressure monitoring device in patients with palliated congenital heart disease: Technical considerations and procedural outcomes. Catheter Cardiovasc Interv 2019; 95:270-279. [DOI: 10.1002/ccd.28528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/02/2019] [Accepted: 09/19/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Arash Salavitabar
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
| | - Elisa A. Bradley
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
- Department of Internal Medicine, Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center Columbus Ohio
| | - Joanne L. Chisolm
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
| | - Jenne Hickey
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
| | - Brian A. Boe
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
| | - Aimee K. Armstrong
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
| | - Curt J. Daniels
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
- Department of Internal Medicine, Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center Columbus Ohio
| | - Darren P. Berman
- The Heart Center, Department of PediatricsNationwide Children's Hospital Columbus Ohio
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Prediction and prevention of sudden cardiac death in transposition of the great arteries: A step closer. Int J Cardiol 2019; 288:68-69. [PMID: 31029496 DOI: 10.1016/j.ijcard.2019.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/20/2022]
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Arrhythmias in Adults With Congenital Heart Disease: What the Practicing Cardiologist Needs to Know. Can J Cardiol 2019; 35:1698-1707. [PMID: 31703824 DOI: 10.1016/j.cjca.2019.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/19/2022] Open
Abstract
The expanding population of adults with congenital heart disease (CHD) combined with the pervasiveness of arrhythmias has resulted in the rapid growth of a dedicated sector of cardiology at the intersection between 2 subspecialties: electrophysiology and adult CHD. Herein, practical considerations are offered regarding urgent referral for catheter ablation of atrial arrhythmias, anticoagulation, and primary prevention implantable cardioverter-defibrillators (ICDs). Patients with Ebstein anomaly and ventricular pre-excitation should be referred promptly due to the high prevalence of multiple accessory pathways and increased incidence of atrial tachyarrhythmias, which may be poorly tolerated. In patients with transposition of the great arteries and atrial switch surgery, atrial arrhythmias should be managed without delay because they could provoke ventricular arrhythmias and sudden death. Other settings in which atrial arrhythmias can be poorly tolerated include single ventricle physiology and Eisenmenger syndrome. Long-term anticoagulation is generally indicated in patients with sustained intra-atrial reentrant tachycardia or atrial fibrillation and a mechanical valve, moderate or severe systemic atrioventricular valve stenosis, traditional risk factors for stroke, and/or moderate or complex CHD. The only class I indication for a primary prevention ICD is a systemic left ventricular ejection fraction ≤ 35%, with biventricular physiology, and New York Heart Association class II or III symptoms. ICD therapy is reasonable in selected adults with tetralogy of Fallot and multiple risk factors for sudden death identified by observational studies. Indications for ICDs in patients with systemic right ventricles and univentricular hearts are less well established, underscoring the need for future research to inform risk stratification.
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Waldmann V, Laredo M, Abadir S, Mondésert B, Khairy P. Atrial fibrillation in adults with congenital heart disease. Int J Cardiol 2019; 287:148-154. [DOI: 10.1016/j.ijcard.2019.01.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
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Lüker J, Sultan A, Sreeram N, Brockmeier K, Steven D. Implantation of a subcutaneous implantable cardioverter defibrillator with right parasternal electrode position in a patient with D-transposition of the great arteries and concomitant AAI pacemaker: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty099. [PMID: 31020176 PMCID: PMC6177110 DOI: 10.1093/ehjcr/yty099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/16/2018] [Indexed: 12/29/2022]
Abstract
Background Implantable cardioverter defibrillator (ICD) therapy is indicated in patients with structural heart disease who have had an aborted cardiac arrest (ACA). After atrial repair of d-transposition of the great arteries (d-TGA, Mustard repair) patients seem to be at a higher risk of failing intraoperative subcutaneous ICD (S-ICD) shock testing. Case summary We report the case of a 45-year-old patient with congenital heart disease (CHD) who suffered a cardiac arrest from ventricular fibrillation and was subsequently implanted with a S-ICD. We describe the challenges of ICD therapy in patients after Mustard procedure for d-TGA, with the additional challenge of concomitant AAI pacemaker therapy. In this patient, we opted for the implantation of an S-ICD, and detail the necessary considerations and operative technique employed in this patient. A right parasternal electrode position was chosen and intraoperative shock testing was successful. Discussion Patients after atrial switch surgery for d-TGA and ACA require careful consideration of the appropriate type of ICD therapy. Subcutaneous ICD implantation with right parasternal electrode position may be a viable option in these patients.
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Affiliation(s)
- Jakob Lüker
- Department of Electrophysiology, University Hospital Cologne, Heart Center, Kerpener Str. 62, Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, University Hospital Cologne, Heart Center, Kerpener Str. 62, Cologne, Germany
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Cologne, Heart Center, Kerpener Str. 62, Cologne, Germany
| | - Konrad Brockmeier
- Department of Pediatric Cardiology, University Hospital Cologne, Heart Center, Kerpener Str. 62, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, University Hospital Cologne, Heart Center, Kerpener Str. 62, Cologne, Germany
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Intraatrial reentrant tachycardia originating from the prior suture line of the baffle in a patient who underwent the Mustard operation: Ultra-high-density 3-dimensional mapping. HeartRhythm Case Rep 2018; 4:451-454. [PMID: 30364620 PMCID: PMC6197406 DOI: 10.1016/j.hrcr.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cardiac Rehabilitation for Adults With Congenital Heart Disease: Physical and Psychosocial Considerations. Can J Cardiol 2018; 34:S270-S277. [DOI: 10.1016/j.cjca.2018.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
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Surgical management of late-term pulmonary venous baffle stenosis after Senning operation. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:653-657. [PMID: 32082812 DOI: 10.5606/tgkdc.dergisi.2018.16158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/03/2018] [Indexed: 11/21/2022]
Abstract
Although pulmonary venous baffle stenosis is not a common late complication after the Senning operation, surgical treatment is vital, when interventional methods fail to correct the pathology. Our patient was admitted to hospital with recurrent epistaxis and exertional dyspnea 6.5 years after the Senning procedure. The gradient in the pulmonary venous baffle was measured as 34 to 35 mmHg via transthoracic echocardiography. During surgical treatment, the calcified and retracted polytetrafluoroethylene flap was completely excised and porcine pericardial xenograft was used to cover the pulmonary venous baffle. At the end of the procedure, no significant gradient was detected via transesophageal echocardiography.
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 500] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Dennis M, Kotchetkova I, Cordina R, Celermajer DS. Long-Term Follow-up of Adults Following the Atrial Switch Operation for Transposition of the Great Arteries – A Contemporary Cohort. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2017.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stewart MH, Macicek SL, Morin DP. Implantable Cardioverter-defibrillators in Adult Congenital Heart Disease. J Innov Card Rhythm Manag 2018; 9:3172-3181. [PMID: 32494493 PMCID: PMC7252815 DOI: 10.19102/icrm.2018.090601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
With improved surgical techniques and medical therapies, many patients who are born with complex congenital heart defects are now living well into adulthood. As these patients age, an increasingly common cause of mortality is sudden cardiac death (SCD) from ventricular tachyarrhythmias. The implantable cardioverter-defibrillator (ICD) is a therapy with the ability to prevent some of these deaths; however, there are many diagnostic and technical challenges that remain in the congenital heart disease (CHD) population. We performed a literature review, searching PubMed for articles that examined the role of ICDs in CHD. We herein present the evidence for when to place an ICD in CHD patients, stratified by subtype as relevant. Then, we discuss the technical challenges and complications that are unique to this patient population. We conclude that, despite active work in the area, more research is needed given the small event rates and clinical variability within CHD populations.
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Affiliation(s)
- Merrill H Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Scott L Macicek
- Department of Pediatric Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
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Roca-Luque I, Rivas-Gándara N, Dos Subirà L, Francisco Pascual J, Pijuan-Domenech A, Pérez-Rodon J, Subirana-Domenech M, Santos-Ortega A, Rosés-Noguer F, Miranda-Barrio B, Ferreira-Gonzalez I, Casaldàliga Ferrer J, García-Dorado García D, Moya Mitjans A. Long-Term Follow-Up After Ablation of Intra-Atrial Re-Entrant Tachycardia in Patients With Congenital Heart Disease. JACC Clin Electrophysiol 2018; 4:771-780. [PMID: 29929671 DOI: 10.1016/j.jacep.2018.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/02/2018] [Accepted: 04/26/2018] [Indexed: 12/15/2022]
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