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IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN PATIENTS WITH SYSTEMIC RIGHT VENTRICLES
S126
239 IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN PATIENTS WITH SYSTEMIC RIGHT VENTRICLES VA Ezzat, K Viswanathan, D Cameron, E Downar, L Harris, K Nair Toronto, Ontario INTRODUCTION:
Patients with L-TGA are believed to be at an increased risk of SCD, however it is unclear what criteria justify ICD implantation. In patients with D-TGA and intraatrial baffles, high appropriate shock rates have been observed in secondary but not primary prevention. METHODS: We describe the baseline characteristics and longterm outcomes of patients with a systemic RV due to either Lor repaired D-TGA and an ICD in situ, in whom at least 2 years of follow-up data were available. Patients with univentricles or CRT therapy were excluded. RESULTS: Thirteen patients were included; 9 with D-TGA (all Mustard repair, 29+/-8.1yrs at implant; 89% male) and 4 with LTGA (36+/-4.2yrs; 100% male). All received dual chambers ICDs, the majority upgraded from PPMs. Implant dates were 2000-2012, mean follow-up 8.5 yrs. Patient characteristics, procedural outcomes and follow-up events are shown in table 1. The D-TGA patients in this cohort had a worse RVEF than the LTGA group. All patients with L-TGA had a bradycardic indication for pacing (AV block). ICD implantation was for primary prevention in all but one. This patient had a syncopal episode, associated with ventricular high rates detected on prior pacemaker and subsequent inducible VT on EPS. No patient with L-TGA had an appropriate therapy during follow-up, whilst all had 1 complication and two patients had 1 inappropriate shock. All were alive at the end of follow-up. In contrast, of the 9 patients with D-TGA, only 5 had a bradycardic indication for pacing (4 sinus node disease, 1 AV block); 7 were implanted for primary prevention. One (implanted for secondary prevention) had an appropriate shock and 6 received 1 inappropriate shocks. Three had died at the end of follow-up, 2 from end stage heart failure and one of complications post-cardiac transplantation.
Canadian Journal of Cardiology Volume 31 2015 CONCLUSION:
In this contemporary cohort of patients with L-TGA and an ICD in situ, long term outcome was good and no patient received an appropriate therapy, however there was a significant amount of morbidity associated with ICD implantation. Mortality in patients with D-TGA was greater, however this was not due to arrhythmic death. Low event and high complication rates were observed in D-TGA primary prevention patients, in keeping with previous data. Risk stratification in patients with systemic RV prior to prophylactic ICD implantation is essential.
240 SURGICAL CLOSURE OF SINUS VENOSUS ATRIAL SEPTAL DEFECT: DOES AGE MATTER? V Lortie, A Mazine, S Poupart, A Dore, NC Poirier Montréal, Québec BACKGROUND:
Sinus venosus atrial septal defect (ASD) is defined by its location at the junction of the right atrium and superior vena cava. Diagnosis is often more difficult than other forms of ASD and many patients remain asymptomatic for many years. As a result, the age of presentation of sinus venosus ASD is highly variable. The purpose of this study was to compare the outcomes of patients of two age groups (Group A: < 60 years and Group B: 60 years) who underwent surgical closure of a sinus venosus atrial septal defect. METHODS: Between August 2001 and October 2013, 28 consecutive adult patients (>18 years) underwent surgical closure of a sinus venosus ASD at our hospital. All patients had associated partial anomalous pulmonary venous connection. Surgical technique consisted in patch roofing of the sinus venosus ASD and rerouting of the pulmonary veins. Three patients (11%) underwent concomitant tricuspid valve repair. There were 18 patients (64%) in Group A and 10 patients (36%) in Group B. Follow-up was 96% complete (1 loss to follow-up) at a mean of 4 7 months. New York Heart Association (NYHA) functional class, freedom from reoperation and survival rates were used to assess the success of the procedure in both groups. RESULTS: Mean age was 46 17 years for the entire cohort and 50% of patients were female. There was one operative mortality in Group B and none in Group A. Early postoperative conduction disorder was frequent in Group B. Two patients (20%) developed first-degree atrioventricular block, two patients (20%) complete right bundle branch block and two patients (20%) received a permanent pacemaker. No conduction disorder was observed in Group A. New-onset atrial fibrillation occurred in two patients (20%) from Group B and none in Group A. At last follow-up, all patients in Group A (100%) and eight patients in Group B (89%) were in NYHA class I. There were no reoperations or late mortalities in either group. CONCLUSION: Surgical closure of sinus venosus ASD can be performed safely in patients aged over 60 years of age. However, data from this single-center study suggest that these patients are at higher risk of postoperative rhythm disorder.
239 IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN PATIENTS WITH SYSTEMIC RIGHT VENTRICLES VA Ezzat, K Viswanathan, D Cameron, E Downar, L Harris, K Nair Toronto, Ontario INTRODUCTION:
Patients with L-TGA are believed to be at an increased risk of SCD, however it is unclear what criteria justify ICD implantation. In patients with D-TGA and intraatrial baffles, high appropriate shock rates have been observed in secondary but not primary prevention. METHODS: We describe the baseline characteristics and longterm outcomes of patients with a systemic RV due to either Lor repaired D-TGA and an ICD in situ, in whom at least 2 years of follow-up data were available. Patients with univentricles or CRT therapy were excluded. RESULTS: Thirteen patients were included; 9 with D-TGA (all Mustard repair, 29+/-8.1yrs at implant; 89% male) and 4 with LTGA (36+/-4.2yrs; 100% male). All received dual chambers ICDs, the majority upgraded from PPMs. Implant dates were 2000-2012, mean follow-up 8.5 yrs. Patient characteristics, procedural outcomes and follow-up events are shown in table 1. The D-TGA patients in this cohort had a worse RVEF than the LTGA group. All patients with L-TGA had a bradycardic indication for pacing (AV block). ICD implantation was for primary prevention in all but one. This patient had a syncopal episode, associated with ventricular high rates detected on prior pacemaker and subsequent inducible VT on EPS. No patient with L-TGA had an appropriate therapy during follow-up, whilst all had 1 complication and two patients had 1 inappropriate shock. All were alive at the end of follow-up. In contrast, of the 9 patients with D-TGA, only 5 had a bradycardic indication for pacing (4 sinus node disease, 1 AV block); 7 were implanted for primary prevention. One (implanted for secondary prevention) had an appropriate shock and 6 received 1 inappropriate shocks. Three had died at the end of follow-up, 2 from end stage heart failure and one of complications post-cardiac transplantation.
Canadian Journal of Cardiology Volume 31 2015 CONCLUSION:
In this contemporary cohort of patients with L-TGA and an ICD in situ, long term outcome was good and no patient received an appropriate therapy, however there was a significant amount of morbidity associated with ICD implantation. Mortality in patients with D-TGA was greater, however this was not due to arrhythmic death. Low event and high complication rates were observed in D-TGA primary prevention patients, in keeping with previous data. Risk stratification in patients with systemic RV prior to prophylactic ICD implantation is essential.
240 SURGICAL CLOSURE OF SINUS VENOSUS ATRIAL SEPTAL DEFECT: DOES AGE MATTER? V Lortie, A Mazine, S Poupart, A Dore, NC Poirier Montréal, Québec BACKGROUND:
Sinus venosus atrial septal defect (ASD) is defined by its location at the junction of the right atrium and superior vena cava. Diagnosis is often more difficult than other forms of ASD and many patients remain asymptomatic for many years. As a result, the age of presentation of sinus venosus ASD is highly variable. The purpose of this study was to compare the outcomes of patients of two age groups (Group A: < 60 years and Group B: 60 years) who underwent surgical closure of a sinus venosus atrial septal defect. METHODS: Between August 2001 and October 2013, 28 consecutive adult patients (>18 years) underwent surgical closure of a sinus venosus ASD at our hospital. All patients had associated partial anomalous pulmonary venous connection. Surgical technique consisted in patch roofing of the sinus venosus ASD and rerouting of the pulmonary veins. Three patients (11%) underwent concomitant tricuspid valve repair. There were 18 patients (64%) in Group A and 10 patients (36%) in Group B. Follow-up was 96% complete (1 loss to follow-up) at a mean of 4 7 months. New York Heart Association (NYHA) functional class, freedom from reoperation and survival rates were used to assess the success of the procedure in both groups. RESULTS: Mean age was 46 17 years for the entire cohort and 50% of patients were female. There was one operative mortality in Group B and none in Group A. Early postoperative conduction disorder was frequent in Group B. Two patients (20%) developed first-degree atrioventricular block, two patients (20%) complete right bundle branch block and two patients (20%) received a permanent pacemaker. No conduction disorder was observed in Group A. New-onset atrial fibrillation occurred in two patients (20%) from Group B and none in Group A. At last follow-up, all patients in Group A (100%) and eight patients in Group B (89%) were in NYHA class I. There were no reoperations or late mortalities in either group. CONCLUSION: Surgical closure of sinus venosus ASD can be performed safely in patients aged over 60 years of age. However, data from this single-center study suggest that these patients are at higher risk of postoperative rhythm disorder.