Zhong Qinghua, Zheng Hongyan, Zhang Zhiwei, Qian Mingyang, Xie Yumei, Wang Shushui
Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China.
Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China. Email:
Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Oct;42(10):840-5.
To evaluate the prevalence and risk factors of arrhythmia after transcatheter closure of ventricular septal defect (VSD) in children.
A total 1 069 children (583 males, mean age (7.7 ± 3.6) years) underwent transcatheter closure of VSD from January 2002 to December 2010 in our hospital were enrolled and retrospectively analyzed.VSD diameters were (4.0 ± 1.8)mm, 336 cases accompanied membranous aneurysm. Electrocardiogram were performed at 1, 3 days after the procedure.Once arrhythmias recorded, electrocardiogram was performed daily till discharge. All cases were followed up by ECG at 1, 3, 6, 12 months after the procedure in outpatient department and then in a year interval. The risk factors were identified by multivariable logistical analysis.
All VSDs were closed successfully and the diameters of occluder was (7.2 ± 2.1)mm. The median follow-up time was 2.2 (1.0-4.2) years. Mortality was zero during follow up.Incidence of early ( < 1 month) post-procedure arrhythmias was 24.6 % (263 cases), and severe arrhythmias were recorded in 50 cases (4.7%). There were 43 late ( ≥ 1 month) post-procedure arrhythmias (4.0%) including 4 (0.4%) complete atrioventricular block. Multivariable logistic analysis revealed that VSD treated with thin-waist-big-side occluder (OR = 2.426, 95%CI:1.835-3.208, P < 0.001) , male gender (OR = 1.267, 95%CI:1.055-1.523, P = 0.011) were the risk factors while higher body weight (OR = 0.838, 95%CI:0.737-0.951, P = 0.006) was protective factor for early onset arrhythmia. Placement of asymmetrical occluder (OR = 4.777, 95%CI:2.079-10.978, P < 0.001) , longer procedure time (OR = 1.011, 95%CI:1.002-1.020, P = 0.012) , occluder from foreign countries (OR = 2.621, 95%CI:1.143-6.014, P = 0.021) were the risks factors for early onset severe conduct block. Treatment with thin-waist-big-side occluder (OR = 2.654, 95%CI: 1.042-6.760, P = 0.041) was the risk factor while higher body weight (OR = 0.373, 95%CI:0.159-0.875, P = 0.023) was a protective factor for late onset conduct block.
Arrhythmia after transcatheter closure of VSD is common in children, and late onset severe conduct block is rare. The weight of patients should not too light and symmetrical occluder should be chosen if possible in the transcatheter closure VSD procedure to minimize the risk of late onset conduct block.
评估儿童室间隔缺损（VSD）经导管封堵术后心律失常的发生率及危险因素。
选取2002年1月至2010年12月在我院接受VSD经导管封堵术的1069例儿童（男583例，平均年龄（7.7±3.6）岁），进行回顾性分析。VSD直径为（4.0±1.8）mm，336例伴有膜部瘤。术后1、3天进行心电图检查。一旦记录到心律失常，每天进行心电图检查直至出院。所有病例在术后1、3、6、12个月在门诊进行心电图随访，之后每年随访一次。通过多变量逻辑分析确定危险因素。
所有VSD均成功封堵，封堵器直径为（7.2±2.1）mm。中位随访时间为2.2（1.0 - 4.2）年。随访期间死亡率为零。术后早期（<1个月）心律失常发生率为24.6%（263例），严重心律失常50例（4.7%）。术后晚期（≥1个月）心律失常43例（4.0%），包括4例（0.4%）完全性房室传导阻滞。多变量逻辑分析显示，使用细腰大边封堵器治疗的VSD（OR = 2.426，95%CI：1.835 - 3.208，P < 0.001）、男性（OR = 1.267，95%CI：1.055 - 1.523，P = 0.011）是早期心律失常的危险因素，而较高体重（OR = 0.838，95%CI：0.737 - 0.951，P = 0.006）是早期心律失常的保护因素。放置不对称封堵器（OR = 4.777，95%CI：2.079 - 10.978，P < 0.001）、手术时间较长（OR = 1.011，95%CI：1.002 - 1.020，P = 0.012）、国外封堵器（OR = 2.621，95%CI：1.143 - 6.014，P = 0.021）是早期严重传导阻滞的危险因素。使用细腰大边封堵器治疗（OR = 2.654，95%CI：1.042 - 6.760，P = 0.041）是晚期传导阻滞的危险因素，而较高体重（OR = 0.373，95%CI：0.159 - 0.875，P = 0.023）是晚期传导阻滞的保护因素。
儿童VSD经导管封堵术后心律失常常见，晚期严重传导阻滞罕见。在VSD经导管封堵术中，患者体重不宜过轻，尽可能选择对称封堵器以降低晚期传导阻滞风险。
