Complete heart block after occlusion and repair for perimembranous ventricular septal defect.

BACKGROUND

Complete atrioventricular conduction block (CAVB) is a major complication of the repair and occlusion of perimembranous ventricular septal defects (pmVSDs).

OBJECTIVE

This study aimed to analyse the incidence and risk factors of CAVB after occlusion and repair of pmVSD.

METHODS

We reviewed patients with pmVSDs who underwent occlusion and repair between January 2010 and January 2022. Permanent CAVB was defined as a CAVB requiring permanent pacemaker implantation or occluder extraction.

RESULTS

Of 2436 patients who underwent pmVSD repair, 7 (0.3%) developed permanent CAVB. In all, 16 (0.7%) of the 2200 patients in the device group developed permanent CAVBs. All permanent CAVBs in the repair group occurred during hospital stay. In contrast, eight (50%) permanent CAVBs in the device group occurred over 1 month. A large pmVSD size (odds ratio [OR], 1.575; 95% confidence interval [CI], 1.260-1.970,  < 0.001) and device/defect ratio (OR, 2.608; 95% CI, 1.587-4.287,  < 0.001) were independent risk factors for permanent CAVB after surgical repair and device occlusion, respectively. Multivariate regression showed that device occlusion versus surgical repair was associated with a significantly higher risk of permanent CAVBs (OR, 4.675; 95% CI, 1.586-13.780,  = 0.005).

CONCLUSION

The incidence rates of permanent CAVB after device occlusion and surgical repair were 0.7% and 0.3%, respectively. Large VSD size and device/defect ratio were independently associated with permanent CAVB after surgical repair and device occlusion, respectively. Compared with surgical repair, device occlusion was associated with a significantly higher risk of permanent CAVB after pmVSD closure.