These patients resemble Eisenmenger VSDs and should be managed as such. Transvenous pacing should be avoided in all patients with residual intracardiac communications since paradoxical emboli may occur. For the same reason, venous thromboemboli from any source are a potential hazard in these patients. Anticoagulants are recommended if a potential source of venous thromboembolism is found. In patients with an atrial switch operation, transvenous pacing leads must traverse the upper limb of the atrial switch to enter the morphological left atrium and left ventricle.
Active fixation is required.
Since all patients will have had some operation, investigations are directed towards post-operative sequelae and will vary according to the type of operation performed. A thorough clinical examination. A Holter monitor because of the high prevalence of sick sinus syndrome and atrial arrhythmias and possible ventricular arrhythmias in older patients. Exercise testing to evaluate heart rate and blood pressure response and to assess whether arrhythmias may be provoked. MRI to evaluate baffle function if not well visualised by other means.