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Sinus node shift after the Senning procedure compared with the mustard procedure for transposition of the great arteries

Authors
Publisher
Elsevier Inc.
Publication Date
Volume
60
Issue
4
Identifiers
DOI: 10.1016/0002-9149(87)90240-2
Keywords
  • Congenital Heart Disease
Disciplines
  • Biology

Abstract

Abstract To investigate the nature of the dominant intrinsic cardiac pacemaker activity after the Senning procedure, endocardial mapping of the systemic venous atrium was accomplished a mean of 13 months after operation in 10 patients, aged 22 ± 6 months. Multiple endocardial sites were measured to find the earliest atrial electrical activity timed back from the QRS complex. These data were compared with data from endocardial mapping performed in 6 patients late after the Mustard procedure. In 8 of 10 patients who had undergone the Senning procedure, the earliest activation time, corresponding by definition to the origin of the intrinsic pacemaker, was located in the inferior medial portion of the superior limb of the systemic venous atrium. In the other 2 patients who had undergone the Senning procedure, the earliest activity was in the high superior limb of the baffle at its junction with the superior vena cava. In contrast, the earliest activity in all patients who underwent the Mustard operation was at the junction of the superior vena cava and the superior limb of the systemic venous atrium. In response to programmed extrastimulation, the electrophysiologic behavior of the intrinsic pacemaker in the Senning group was abnormal compared with known normal sinus node (SN) data in only 3 of 10 patients, whereas all patients in the Mustard group had SN dysfunction. Abnormal SN function was noted in both patients in the Senning group, in whom a shift in the position of the earliest endocardial activation point was not seen. The anatomic shift in the position of the earliest pacemaker activity observed after the Senning procedure, but not after the Mustard operation, results from a physical shift in the position of the SN inherent to the atrial free-wall infolding aspect of the Senning operation.

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