Author + information
- Received May 6, 1985
- Revision received July 30, 1985
- Accepted August 16, 1985
- Published online January 1, 1986.
- Paul C. Gillette, MD, FACCa,
- Deborah G. Wampler,
- Cathleen Shannon, RN and
- David Ott, MD
- ↵aAddress for reprints: Paul C. Gillette, MD, South Carolina Children's Heart Center, Pediatric Cardiology, 171 Ashley Avenue, Charleston, South Carolina 29425.
The most frequent complication of the venous redirection (Mustard or Senning) operation for transposition of the great arteries is cardiac arrhythmia. Drug treatment of tachyarrhythmia often worsens bradyarrhythmia. Pacemakers can now treat both arrhythmias. The technique for implantation of pacemakers after redirection for transposition has changed over time from thoracotomy to subxiphoid to transvenous. Atrial pacing is almost always the mode of choice since the electrophysiologic abnormality is sinus node dysfunction with intact atrioventricular conduction.
Twenty-nine patients aged 3 to 19 years (mean 9.6) had implantation of a pacemaker a mean of 5.5 years (range 1 to 14) after undergoing the Mustard operation for transposition of the great arteries. Symptoms referable to bradycardia were eliminated in each case. Four patients who received an antitachycardia pacemaker no longer have symptomatic tachycardia. Four patients have required reoperation, three because of lead problems and one because of traumatic erosion of the pacemaker.
Pacemakers provide excellent relief of symptoms after the Mustard or Senning operation. Transvenous atrial automatic antitachycardia pacemakers offer the best combination of ease of implantation and symptomatic relief.
- Received May 6, 1985.
- Revision received July 30, 1985.
- Accepted August 16, 1985.
- American College of Cardiology Foundation