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Trans-baffle or Retrograde Aortic Approach for Atrial Arrhythmias Ablation in Patients with D-Transposition of the Great Arteries Palliated with Atrial Switch.

Heart Rhythm

January 2025

Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron. . Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.

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Background: Patients with systemic right ventricle (SRV), either d-transposition of the great arteries following an atrial switch procedure or congenitally corrected transposition of the great arteries, develop severe right ventricular dysfunction, prompting appropriate medical therapy. However, the efficacy of beta-blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in SRV patients is unproven.

Objectives: The objective of this study was to determine the effects of ACEI/ARB and beta-blockers on outcomes in SRV patients after accounting for likely cofounders affecting their use.

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: While it is generally assumed that common neurobehavioral assessments, such as the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), function similarly in clinical and non-clinical populations, this has not been validated in adults with congenital heart disease (CHD). In this study, we examined the latent factor structure of the WAIS-IV in adults with d-transposition of the great arteries (d-TGA) who participated in the Boston Circulatory Arrest Study. : The WAIS-IV was administered as part of a larger assessment battery.

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Since the late 1980s, the standard approach for treating D-transposition of the great arteries has been the arterial switch operation (ASO), replacing the Mustard/Senning procedure. Although ASO has shown impressive long-term survival rates, recent case series have revealed late complications such as neoaortic dilation and coronary artery stenosis. New findings emphasize the need for comprehensive evaluation of coronary risk and a deeper understanding of the mechanisms leading to coronary artery stenosis and myocardial ischemia over the long term.

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Aims: Patients with D-transposition of the great arteries (D-TGA) and atrial switch experience late morbidity and mortality related to atrial arrhythmias and systemic right ventricular (SRV) failure. We sought to analyze the influence of atrial arrhythmias on long-term outcomes in this group.

Methods: A retrospective review of all patients with D-TGA and atrial switch followed at a tertiary care center was performed.

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