American heart journal · 2026
Outcomes of implantable cardioverter-defibrillator implantation in adults with congenitally corrected transposition of great arteries.
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Egbe Alexander C, Kholeif Zeyad, Madhavan Malini, Deshmukh Abhishek J, DeSimone Christopher V
Аннотация
BACKGROUND: Ventricular arrhythmias and sudden cardiac death (SCD) are common in adults with congenitally corrected transposition of great arteries (cc-TGA). The purpose of this study was to describe the outcomes after implantable cardioverter-defibrillator (ICD) implantation in adults with cc-TGA.
METHOD: Retrospective cohort study of adults with cc-TGA who underwent ICD implantation at Mayo Clinic (2003-2024). Indications for ICD implantation were classified as primary versus secondary prevention. Study outcomes were appropriate and inappropriate ICD shocks. Exploratory outcomes were device-related complications and mortality.
RESULTS: Of 278 patients, 87 (31%) underwent ICD implantation (age 45±15 years, 59% males; primary prevention [N = 67, 77%], secondary prevention [N = 20, 23%]). Overall, 14 (16%) patients received appropriate ICD shock. The annual incidence of appropriate ICD shock was 3.7% per year and was lower in the primary versus secondary prevention groups (1.9% versus 8.2% per year, P = .006). Overall, 11 (13%) patients received inappropriate ICD shock, yielding annual incidence of 3.5% per year. This was similar between the 2 groups. Apart from ICD implantation for secondary prevention, none of the conventional risk factors were associated with an appropriate ICD shock. All-cause mortality was high (31%) among the cohort, but none of the patients experienced SCD.
CONCLUSIONS: We observed a high rate of appropriate ICD shock, especially in the secondary prevention group. However, risk stratification of ICD implantation for primary prevention remains challenging. The absence of SCD (despite a high prevalence of all-cause mortality) suggest that ICD implantation may provide a survival benefit.
METHOD: Retrospective cohort study of adults with cc-TGA who underwent ICD implantation at Mayo Clinic (2003-2024). Indications for ICD implantation were classified as primary versus secondary prevention. Study outcomes were appropriate and inappropriate ICD shocks. Exploratory outcomes were device-related complications and mortality.
RESULTS: Of 278 patients, 87 (31%) underwent ICD implantation (age 45±15 years, 59% males; primary prevention [N = 67, 77%], secondary prevention [N = 20, 23%]). Overall, 14 (16%) patients received appropriate ICD shock. The annual incidence of appropriate ICD shock was 3.7% per year and was lower in the primary versus secondary prevention groups (1.9% versus 8.2% per year, P = .006). Overall, 11 (13%) patients received inappropriate ICD shock, yielding annual incidence of 3.5% per year. This was similar between the 2 groups. Apart from ICD implantation for secondary prevention, none of the conventional risk factors were associated with an appropriate ICD shock. All-cause mortality was high (31%) among the cohort, but none of the patients experienced SCD.
CONCLUSIONS: We observed a high rate of appropriate ICD shock, especially in the secondary prevention group. However, risk stratification of ICD implantation for primary prevention remains challenging. The absence of SCD (despite a high prevalence of all-cause mortality) suggest that ICD implantation may provide a survival benefit.