Clinical Research Of Arrhythmia After Transcatheter Closure Of Perimembranous Ventricular Septal Defects

Objective To investigate the types and prognosis of new arrhythmia after transcatheter closure of perimembranous ventricular septal defects (PMVSD)and the risk factors of the arrhythmia.Methods A retrospective analysis was performed on 228 PMVSD patients who accepted transcatheter closure successfully in the First Affiliated Hospital of Nanjing Medical University from January 2003 to May 2007.â‘ The types of arrhythmia were observed according to the ECG and Holter in all patients who were taken both pre-and postprocedure;â‘¡Observation of the position,shape and size of the PMVSD with echocardiography,and measurement of the distance from lower margin of the defects to septal leaflet of the tricuspid valve(DDSTV);â‘¢Pulmonary artery systolic pressure was recorded by right cardiac catheterization;the size of the defects and the distance from upper margin of the defects to the ring of the right aortic valve(DDRAV) were measured by left ventricular angiography,and suitable occluders were chosen to close the defects;â‘£ECG and Holter were followed up in all patients at 1,3,6 months and every year after the procedure.Resultsâ‘ 127 case-times of new arrhythmia were detected in 94 patients(41.2%)which included 53(41.7%)of bundle branch block, 13(10.2%)of atrioventricular block and 61(48.0%)of ectopic arrhythmia. 15(11.8%)case-times continued in the follow-up in which 14 case-times were RBBB.â‘¡DDSTV was the risk factor of all new arrhythmia after transcatheter closure,and DDRAV was the risk factor of ectopic arrhythmia.The risk factor of the persistence of RBBB was the emergence time of it.â‘¢Patients with LBBB,advanced orâ…¢degree atrial ventricular block must be administrated with hormones or temporary pacing treatment,while others only need bedside ECG monitor in order to prevent the occurrence of accidents.Conclusion Arrhythmia is a common complication after transcatheter closure of PMVSD,but with low rate of severe arrhythmia.In addition to patients with LBBB,advanced orâ…¢degree atrial ventricular block, others only need bedside ECG monitor.RBBB was the main type of continuously existing of the new arrhythmia.DDSTV was the common risk factor of the arrhythmia after transcatheter closure,and DDRAV was the risk factor of ectopic arrhythmia.It was important to screen the high-risk patients and avoid post-operative arrhythmia through measurement of the DDSTV and DDRAV.