PMID- 17383987
OWN - NLM
STAT- MEDLINE
DCOM- 20070807
LR  - 20070418
IS  - 1099-5129 (Print)
IS  - 1099-5129 (Linking)
VI  - 9
IP  - 5
DP  - 2007 May
TI  - Cardiac defibrillation therapy for at risk patients with systemic right 
      ventricular dysfunction secondary to atrial redirection surgery for 
      dextro-transposition of the great arteries.
PG  - 281-4
AB  - AIM: To review techniques of implantable cardioverter-defibrillators (ICD) in 
      patients after Mustard surgery for arterial transposition. METHODS AND RESULTS: 
      Retrospective analysis of all Mustard patients receiving ICDs at our institution. 
      Five patients (median age 24 years, range 19-35, 3 male) with systemic right 
      ventricular dysfunction (sRV) dysfunction and New York Heart Association (NYHA) 
      II and III, received ICDs. Implantation was performed transvenously in three 
      patients, epicardial patches and subcutaneous arrays at surgery in two patients. 
      Two patients required lead extraction and baffle stent angioplasty before ICD 
      implantation. Defibrillation vectors incorporating the anterior sRV mass [i.e., 
      sub-pulmonary left ventricle (pLV) to generator can, and between epicardial 
      defibrillator patches], consistently achieved a minimum 10 joule(J) safety margin 
      during defibrillation threshold (DFT) testing. Subcutaneous arrays and 
      endocardial vectors that included a superior vena cava (SVC) electrode were less 
      effective. One patient developed pulmonary oedema post-procedure. At a median 20 
      months, all patients were alive and in NYHA class II. Follow-up over 24 months 
      documented multiple non-sustained ventricular tachycardia (VT) in the group and 
      one patient had recurrent VT with aborted device therapy. CONCLUSION: 
      Defibrillator implantation in Mustard patients is challenging. Sub-optimal 
      defibrillation should be anticipated and can be overcome using vectors which 
      integrate the RV mass and high-energy devices. A staged procedure involving 
      pre-implant interventions or separate DFT tests, where indicated, may be better 
      tolerated by patients.
FAU - Michael, Kevin A
AU  - Michael KA
AD  - Department of Clinical Electrophysiology, Wessex Cardiothoracic Centre, 
      Southampton, UK. kevin_a_michael@yahoo.co.uk
FAU - Veldtman, Gruschen R
AU  - Veldtman GR
FAU - Paisey, John R
AU  - Paisey JR
FAU - Yue, Arthur M
AU  - Yue AM
FAU - Robinson, Stephen
AU  - Robinson S
FAU - Allen, Stuart
AU  - Allen S
FAU - Sunni, Nadia S
AU  - Sunni NS
FAU - Kiesewetter, Chris
AU  - Kiesewetter C
FAU - Salmon, Tony
AU  - Salmon T
FAU - Roberts, Paul R
AU  - Roberts PR
FAU - Morgan, John M
AU  - Morgan JM
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20070323
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cardiac Surgical Procedures/*adverse effects/methods
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Atria/physiopathology/*surgery
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Transposition of Great Vessels/physiopathology/*surgery
MH  - Ventricular Dysfunction, Right/*etiology/*therapy
EDAT- 2007/03/27 09:00
MHDA- 2007/08/08 09:00
CRDT- 2007/03/27 09:00
PHST- 2007/03/27 09:00 [pubmed]
PHST- 2007/08/08 09:00 [medline]
PHST- 2007/03/27 09:00 [entrez]
AID - eum001 [pii]
AID - 10.1093/europace/eum001 [doi]
PST - ppublish
SO  - Europace. 2007 May;9(5):281-4. doi: 10.1093/europace/eum001. Epub 2007 Mar 23.