Journal article
Hemodynamic Assessment with Interventional Support Should Be Routine for Primary Electrophysiology Procedures after Atrial Switch Procedure
Congenital heart disease, Vol.10(2), pp.E83-E88
03/2015
DOI: 10.1111/chd.12227
PMID: 25346415
Abstract
Objectives
We sought to review our current philosophy that all primary invasive electrophysiologic (EP) studies in patients with atrial switch procedures (ASPs) should undergo hemodynamic evaluation and have interventional expertise available.
Background
Patients who have undergone an ASP for dextro‐transposition of the great arteries have a high incidence of both hemodynamic and EP sequelae. We present our data to support the combined assessment approach for these patients.
Methods
Hemodynamic evaluation and interventions performed concurrently during a primary invasive EP procedure in patients with ASP were reviewed.
Results
A total of 18 patients underwent concurrent EP invasive procedure and cardiac catheterization. The median age was 31 (14–43 years) with the majority being male (67%). Patients underwent a total of 30 concurrent primary invasive EP procedure and cardiac catheterization; 14 (47%) of the catheterization procedure were interventional. Some of the catheterization procedures required more than one intervention with total of 19 separate interventions. There were nine (47%) unexpected interventions. The majority of patients (n = 14, 77.8%) had one or more abnormal hemodynamic finding including baffle obstruction (n = 13, 72%), elevated filling pressures (n = 3, 17%), and secondary pulmonary hypertension (n = 3, 17%). Non‐EP–related interventional procedures included systemic or pulmonary venous baffle stenting for significant obstruction (n = 7). EP‐related interventions included transbaffle puncture for ablation of left‐sided reentry circuits (n = 5), closure of previously undiagnosed baffle leaks prior to pacemaker/implantable cardioverter defibrillator (ICD) placement to prevent paradoxical embolism (n = 3), superior baffle stenting to facilitate pacemaker/ICD lead placement (n = 2), and retrieval of retained transvenous pacemaker/ICD lead (n = 2).
Conclusion
Due to the frequency of abnormal hemodynamics or interventional needs, strong consideration for routine concurrent hemodynamic assessment and availability of interventional expertise is warranted during primary invasive EP procedures in patients post ASP.
Details
- Title: Subtitle
- Hemodynamic Assessment with Interventional Support Should Be Routine for Primary Electrophysiology Procedures after Atrial Switch Procedure
- Creators
- Osamah Aldoss - University of Iowa Children's HospitalNicholas Von Bergen - University of Iowa Children's HospitalIan Law - University of Iowa Children's HospitalAbhay Divekar - University of Iowa Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Congenital heart disease, Vol.10(2), pp.E83-E88
- DOI
- 10.1111/chd.12227
- PMID
- 25346415
- ISSN
- 1747-079X
- eISSN
- 1747-0803
- Number of pages
- 6
- Language
- English
- Date published
- 03/2015
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984093233202771
Metrics
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