Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance

Baruteau, Alban‐Elouen; Abrams, Dominic J.; Ho, Siew Yen; Thambo, Jean-Benoît; McLeod, Christopher J.; Shah, Maully J.

doi:10.1161/jaha.117.007759

Cited by 73 publications

(69 citation statements)

References 50 publications

(94 reference statements)

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“… 5 Furthermore, the complex anatomic arrangement of conduction systems within the cc-TGA heart may lead to normal, anterior, or dual AV nodal systems, adding to variability in arrhythmia presentation. 6 Our patient’s particular subset of associated congenital defects and surgical history makes her condition exceptionally rare.…”

Section: Discussionmentioning

confidence: 91%

Successful Catheter Ablation of Two Macro-reentrant Atrial Tachycardias in a Patient with Congenitally Corrected Transposition of the Great Arteries: A Case Report

Pennoyer¹,

Bykhovsky²,

Sohinki³

et al. 2020

J Innov Cardiac Rhythm Manage.

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Adults with congenital heart disease represent a complex and growing patient population. By virtue of their variant anatomy and the complex surgical repair often required in infancy, these patients are at risk of developing unique atrial and ventricular arrhythmias throughout their lifetimes. Electrophysiologists involved in the care of these patients should have a detailed understanding of their underlying anatomy and any prior surgical procedures to guide procedural planning and should have knowledge of the range of possible arrhythmia mechanisms that may differ from patients without structural heart disease. Despite this complexity, standard mapping techniques and electrophysiologic maneuvers may still be used to elucidate arrhythmia mechanisms, map tachycardia circuits, and guide catheter ablation. We report a case of two different macroreentrant right atrial tachycardias that were successfully ablated in a patient with congenitally-corrected transposition of the great arteries.

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Section: Discussionmentioning

confidence: 91%

Successful Catheter Ablation of Two Macro-reentrant Atrial Tachycardias in a Patient with Congenitally Corrected Transposition of the Great Arteries: A Case Report

Pennoyer¹,

Bykhovsky²,

Sohinki³

et al. 2020

J Innov Cardiac Rhythm Manage.

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“…AVB in this population is consistently associated with poor outcomes[ 6 ]. However, our study results suggest that operative strategy may not make a huge incremental difference in the development of AVB.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with cc-TGA are prone to developing atrioventricular block (AVB) requiring pacemaker implantation regardless of operative intervention[ 5 , 6 ]. Furthermore, the baffles for systemic and pulmonary venous return have been shown to place patients at long-term risk for the development of atrial arrhythmia, though this risk might be mitigated by having a systemic left ventricle[ 6 , 7 ]. Postoperative baffle leaks and stenoses are an additional complication that can lead to a variety of symptomology including cyanosis, paradoxical embolism, or venous congestion.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of outcomes of anatomic repair in congenitally corrected transposition of great arteries

Chatterjee

Miller

Cribbs

et al. 2020

WJC

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BACKGROUND Treatment of congenitally corrected transposition of great arteries (cc-TGA) with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation. However, data on long term outcomes are limited to single center reports and include small sample sizes. AIM To perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA. METHODS MEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31, 2017. Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software. RESULTS Eight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years (PY). Pooled estimate for operative mortality was 8.3% [95% confidence interval (CI): 6.0%-11.4%]. 0.2% (CI: 0.1%-0.4%) patients required mechanical circulatory support postoperatively and 1.7% (CI: 1.1%-2.4%) developed post-operative atrioventricular block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5% (CI: 89.5%-95.4%) per 100 PY and a low rate of need for pacemaker (0.3/100 PY; CI: 0.1-0.4). 84.7% patients (CI: 79.6%-89.9%) were found to be in New York Heart Association (NYHA) functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3 per 100 PY (CI: 3.8-6.8). CONCLUSION Operative mortality with anatomic repair strategy for cc-TGA is high. Despite that, transplant free survival after anatomic repair for cc-TGA patients is highly favorable. Majority of patients maintain NYHA I/II functional class. However, monitoring for burden of re-interventions specific for operation type is very essential.

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“…However, the intrinsic abnormality of the AV conduction system, with the AV node aberrantly located anteriorly and the His bundle on the pulmonary outflow, puts ccTGA patients at risk of wear and tear injury, which explains onset of AV block and cardiac arrest. Reportedly, one half of this patient population requires a pacemaker [54] (Table 1).…”

Section: Congenitally Corrected Transposition Of Great Arteries (Cctga)mentioning

confidence: 99%

Autopsy in adults with congenital heart disease (ACHD)

et al. 2020

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The adult congenital heart diseases (ACHD) population is exceeding the pediatric congenital heart diseases (CHD) population and is progressively expanding each year, representing more than 90% of patients with CHD. Of these, about 75% have undergone surgical and/or percutaneous intervention for palliation or correction. Autopsy can be a very challenging procedure in ACHD patients. The approach and protocol to be used may vary depending on whether the pathologists are facing native disease without surgical or percutaneous interventions, but with various degrees of cardiac remodeling, or previously palliated or corrected CHD. Moreover, interventions for the same condition have evolved over the last decades, as has perioperative myocardial preservations and postoperative care, with different long-term sequelae depending on the era in which patients were operated on. Careful clinicopathological correlation is, thus, required to assist the pathologist in performing the autopsy and reaching a diagnosis regarding the cause of death. Due to the heterogeneity of the structural abnormalities, and the wide variety of surgical and interventional procedures, there are no standard methods for dissecting the heart at autopsy. In this paper, we describe the most common types of CHDs that a pathologist could encounter at autopsy, including the various types of surgical and percutaneous procedures and major pathological manifestations. We also propose a practical systematic approach to the autopsy of ACHD patients.

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Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance

Cited by 73 publications

References 50 publications

Successful Catheter Ablation of Two Macro-reentrant Atrial Tachycardias in a Patient with Congenitally Corrected Transposition of the Great Arteries: A Case Report

Successful Catheter Ablation of Two Macro-reentrant Atrial Tachycardias in a Patient with Congenitally Corrected Transposition of the Great Arteries: A Case Report

Systematic review and meta-analysis of outcomes of anatomic repair in congenitally corrected transposition of great arteries

Autopsy in adults with congenital heart disease (ACHD)

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