Bouzeman Abdeslam, Marijon Eloi, de Guillebon Maxime, Ladouceur Magalie, Duthoit Guillaume, Amet Denis, Martins Raphael, Otmani Akli, Lavergne Thomas, Bordachar Pierre, Celermajer David S, Thambo Jean-Benoit, Iserin Laurence, Combes Nicolas
European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center, Paris, France.
European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France.
Int J Cardiol. 2014 Nov 15;177(1):301-6. doi: 10.1016/j.ijcard.2014.09.015. Epub 2014 Sep 28.
The experience with the implantable cardiac defibrillator (ICD) in patients with transposition of the great arteries (TGA) and history of atrial switch surgery remains limited.
Retrospective evaluation aiming to assess characteristics and outcomes of consecutive TGA patients with history of atrial switch surgery implanted with an ICD between January 2005 and June 2012 in four French centers.
Of the 12 patients (median 34 years [28, 40]; 67% male), 4 patients (33%) were implanted for secondary prevention after symptomatic documented sustained ventricular tachycardia or sudden cardiac arrest. ICDs were implanted for primary prevention in 8 patients (67%), including cardiac resynchronization in 3 patients; severe systemic ventricle dysfunction was present in all cases (median ejection fraction 27% [20, 40]). Overall, one patient died during the ICD implantation secondary to refractory cardiac arrest after defibrillation testing. Over a median follow-up of 19 months [10, 106], 6 patients out of 11 (54%) experienced worsening of congestive heart failure, including 5 who were eventually transplanted. Overall, 3 patients (27%) experienced significant ICD-related complications, whereas only one patient (primary prevention indication) developed appropriate ICD therapy (successful anti-tachycardia pacing without shock). Half of the patients presented with at least one episode of sustained (≥ 5 min) atrial arrhythmia during follow-up.
Our findings underline the key role of progressive heart failure in dictating outcomes among TGA patients with prior atrial switch repair. Our results also underline the need of better risk-stratification for sudden cardiac death in those patients.
对于大动脉转位（TGA）且有房内转换手术史的患者，植入式心脏除颤器（ICD）的应用经验仍然有限。
进行回顾性评估，旨在评估2005年1月至2012年6月间在法国四个中心接受ICD植入的、有房内转换手术史的连续性TGA患者的特征及预后。
12例患者（年龄中位数34岁[28, 40]；67%为男性）中，4例（33%）因有症状的持续性室性心动过速或心脏骤停记录而植入ICD进行二级预防。8例（67%）患者植入ICD进行一级预防，其中3例进行心脏再同步治疗；所有病例均存在严重的体循环心室功能障碍（射血分数中位数27%[20, 40]）。总体而言，1例患者在ICD植入期间因除颤测试后难治性心脏骤停死亡。在中位随访19个月[10, 106]期间，11例患者中的6例（54%）出现充血性心力衰竭恶化，其中5例最终接受了心脏移植。总体而言，3例患者（27%）出现了与ICD相关的严重并发症，而只有1例患者（一级预防适应证）接受了适当的ICD治疗（成功的抗心动过速起搏且未电击）。一半的患者在随访期间至少出现过一次持续（≥5分钟）的房性心律失常。
我们的研究结果强调了进行性心力衰竭在决定既往接受房内转换修复的TGA患者预后中的关键作用。我们的结果还强调了对这些患者进行更好的心脏性猝死风险分层的必要性。
