ABSTRACT
Four patients with d-TGA after atrial switch operation were treated with transvenous DDD pacemaker implantation for their postoperative dysrhythmia; complete atrioventricular block (CAVB) in two, sinus bradycardia with grade I atrioventricular block in one after the Mustard procedure and CAVB with sick sinus syndrome after the Senning procedure in one. From an anatomical point of view, the left atrial appendage was the only suitable anchoring site for the atrial lead. The patency of this cavity should be assessed by echocardiography and/or angiography before implantation. As for the ventricular lead, active fixation is recommended because of the relatively smooth endocardial surface of morphological left ventricle. Otherwise, transvenous DDD pacemaker implantation for patients after atrial switch operation was safely performed without any technical difficulties and with few complications.