Left Anterior Fascicular Block After Transcatheter Closure Of Ventricular Septal Defect In Children

Objectives This study presents the clinical characteristics,prognosis,and related risk factors of left anterior fascicular block after transcatheter closure of ventricular septal defect in children.Methods The clinical and follow-up data of the patients suffered LAFB after transcatheter closure of VSD in the Heart Center of Children’s Hospital of Chongqing Medical University from June 2009 to October2018 were reviewed.The clinical data include clinical symptoms and signs,gender,age,weight,preoperative ECG and echocardiography,results of catheterization and angiography,ECG and echocardiography during postoperative hospitalization.Follow-up data include follow-up time,weight,clinical symptoms and signs,ECG and echocardiography.Results There were 30 cases eligible of all 1371 cases,having an incidence of 2.2%（30/1371）among all patients,11.8%（30/255）among all postprocedural arrhythmias,23.3%（30/129）among all postprocedural bundle branch block.Among the 30 cases,there were 17 males and 13females with an average age of 4.6±2.1 years（range 23-105 months）,average body surface area（BSA）:0.60±0.13 m²,VSD size（Angiography）:3.7±1.8 mm,the ratio between diameter of VSD and BSA(d _VSD/BSA):5.6±2.1（mm/m²）,occluder size:6.9±1.8 mm,the diameter difference between the occluder size and VSD size（DDOV）:3.3±1.0 mm.Electrocardiogram showed left anterior fascicular block within 3 days and the most patients gradually returned to normal within 1 to 2 years,showing a LAFB-Left axis deviation-Normal dynamic change.Left ventricular end-diastolic dimension Z score ranged-2 to 2 in all children,and no decrease of left ventricular ejection fraction was found in all children.The high ratio between ventricular septal defect size and body surface area（p<0.05,OR 2.6,95%CI:1.136-6.113）,large diameter difference between the occluder size and ventricular septal defect size（p<0.05,OR2.1,95%CI:1.036-4.609）were independent risk factors for postprocedural left anterior fascicular block.Conclusions The incidence of postprocedural left anterior fascicular block is not that low and the overall prognosis is quite good at the current follow-up stage.No progressive severity has been found such as complete left bundle branch block,double（triple）bundle branch block and atrioventricular block to have influence on cardiac systolic and diastolic function.