73
4.4.1.1. Patients With dextro-Transposition of the Great
Arteries and Atrial Switch
COR LOE
Recommendations
erapeutic
1 B-NR
8. In adults with d-TGA and atrial switch who have atrial
arrhythmias, rhythm control strategies are preferable to rate
control strategies to reduce symptoms and prevent heart
failure.
1 C-LD
9. Adults with d-TGA and atrial switch who have symptoms
attributable to a baffle leak should undergo closure of the leak
to improve symptoms and quality of life.
1 C-LD
10. In adults with d-TGA and atrial switch who have symptoms
attributable to systemic or pulmonary venous pathway
stenosis or liver congestion, intervention to relieve the
stenosis is indicated to improve symptoms and prognosis.
1 C-LD
11. Adults with d-TGA and atrial switch who have worsening
symptoms of exercise intolerance, heart failure, or arrhythmia
refractory to treatment should be referred to a heart
failure program for assessment for mechanical support and
transplantation in consultation with an ACHD cardiologist,
to improve quality of life and prolong survival.
2a C-LD
12. In adults with d-TGA and atrial switch who have sustained
intra-atrial reentrant arrhythmias or atrial fibrillation, oral
anticoagulation can be useful to prevent embolic events.
2a C-EO
13. Adults with d-TGA and atrial switch who require
transvenous lead placement can benefit from catheter-based
interventions to address residual baffle leaks or obstruction
before lead placement, to reduce the risk for systemic
thromboembolism and/or future baffle occlusion.
2b B-NR
14. Symptomatic adults with d-TGA and atrial switch who have a
failing systemic right ventricle and a QRS duration >150 ms
related to chronic ventricular pacing may be considered for
CRT to improve symptoms.
2b B-R
15. In adults with d-TGA and atrial switch who have heart
failure with reduced RV function, it may be reasonable to
use GDMT for heart failure with reduced ejection fraction
in order to treat the heart failure and improve symptoms,
ventricular function, and outcomes.
(cont'd)
