Cardiac transplantation for the treatment of adults with congenital heart disease: a single center experience

patients who had an ICD placed for ventricular tachycardia or syncope with known left ventricular dysfunction and/or severe transplant coronary artery disease (TCAD). Methods: Six heart transplant patients with symptoms of left ventricular dysfunction and/or severe TCAD by angiography presented with syncope or non-sustained ventricular tachycardia on cardiac monitoring. Due to the implied risk of sudden death, these patients underwent percutaneous ICD placement [Medtronic (2), Guidant, Atlas, Ventak, CPI]. Results: The average age of the six patients was 58 years and the average time to ICD after heart transplant was 82 months (range 53 to 155 months). 4/5 patients had reduced echo left ventricular ejection fraction between 18 and 45% and 5/6 patients had severe 2 to 3 vessel TCAD. 2/6 patients died suddenly within four months of having the ICD placed. The two patients had progression of TCAD at absaopsy. The four remaining patients have had no firing of the ICD and have had routine ICD follow-up. The longest patient has had the ICD for 65 months with progression of his TCAD. Conclusion: ICD placement does not necessarily protect heart transplant patients from sudden death especially if they have progression of underlying TCAD. Further experience with ICD in heart transplant patients is needed prior to establishing a policy regarding the use of this life saving device.