The Study Of Arrhythmia Related Factors And Heart Rate Variability In Patients With Transcatheter Occlusion Of VSD

Background and Objective Arrhythmia is a common complication of transcatheter occlusion for ventricular septal defect( VSD), which not only influences the recovery of cardiac function after transcatheter occlusion, but also directly relates to the prognosis. Heart rate variability (HRV) is a sensitive, objective and noninvasive method for assessment of cardiovascular autonomic nerve function system so far. This study aims at analyzing retrospectively arrhythmia related factors at early stage after transcatheter occlusion of VSD, in order to prevent and interfere with the arrhythmia as early as possible. Meanwhile the parameters of HRV were detected by dynamic ECG in some patients with transcatheter occlusion of VSD, in order to investigate the clinical significance of HRV in transcatheter occlusion of VSD. Methods Eighty patients admitted to pediatric department in Shandong provincial hospital for transcatheter occlusion of VSD during February in 2004 to February in 2007 were selected. They undertook ECG examination in 1 day pre-interventional therapy, 1 day, 3 day and 5 day post- interventional therapy. Thirty of them received 24 hour Holter and HRV analysis such as SDNN,SDANN,PNN₅₀,RMSSD,LF,HF and LF / HF before and after interventional therapy.Results 1.Among eighty patients with VSD, seventy seven patients performed transcatheter occlusion successfully (96.25%).Thirty two of them used eccentric Amplatzer occluder, fourty three of them used symmetric or unsymmetric concentric circle occluder, one of them used Amplatzer PDA occluder and one of them used cook coil.2.Totally thirty five of patients with VSD occlusion occurred different types of arrhythmia(45.45%), nine patients occurred AVB(11.69%), twenty eight patients occurred BBB(36.36%), four patients occurred nonparoxysm junctional tachycardia, three patients occurred nonparoxysm ventricular tachycardia(9.09%), Among thirty five patients, nine patients occurred more than two types of arrhythmia(11.69%).3.The incidence and type of arrhythmia has correlated with age. The incidence of arrhythmia was 56.25% in patients at age of three to five, 30.30% in patients at age of six to eighteen and 58.33% in patients more than eighteen years old. The incidence of arrhythmia in patients at age of three to five and more than eighteen was much higher than that in the patients at age of six to eighteen. The patients at age of three to five(50.00%) were much more easier to suffer from conductional block than that in more than six years old patients(26.67%) (P<0.05).4.The incidence of arrhythmia in patients whose VSD diameter was less than eight mm (36.73%) was lower than that in patients whose VSD diameter was more than eight mm(64.29%)(P<0.05). The incidence of arrhythmia in patients with VSD membranous aneurysm formulation (24.32%) were much lower than that in patients without VSD membranous aneurysm formulation (67.52%)(P<0.05).The incidence of arrhythmia in patients whose type of VSD occluder was less than eight mm (37.74%)was lower than that in patients whose type of VSD occluder was more than eight mm (63.64)( P<0.05).5.The incidence of arrhythmia in patients whose time of setting up of femoral artery to femoral vein track less than sixty minutes (30.30%) were lower than that in patients whose total procedure time more than sixty minutes(59.09%)( P <0.05).6.The SDNN (124.60±22.63), RMSSD (50.47±10.59) , PNN₅₀ (23.45±8.29)and HF (17.70±4.46) in patients after VSD occlusion increased significantly than theSDNN (95.10±15.26), RMSSD (44.90±9.81) , PNN₅₀ (15.43±4.67) and HF(15.49±4.15) in patients before the procedure (all of P<0.05). While their SDANN,LF and LF/HF have no obvious change. Conclusions 1 .The successful rate of transcatheter VSD occlusion is high.2.The arrhythmia is a common complication of transcatheter occlusion of VSD. 3.The incidence and type of arrhythmia has correlated with age. The patients at age of three to five and more than eighteen were much more easier to suffer from arrhythmia. The incidence of conductional block in patients at age of three to five was higher.4.The patients with VSD diameter more than eight mm, type of VSD occluder more than eight mm, total time of establishment of femoral artery to femoral vein track longer than sixty minutes and without VSD membranous aneurysm formulation were likely to suffer from arrhythmia.5.The SDNN, RMSSD, PNN₅₀ and HF in patients after VSD occlusion increased significantly than that of the patients before the procedure. It indicates that the vagus nerve tension of the patients with VSD occlusion reinforced and sympathetic activity decreased, which might have related with improved cardiac function after the interventional therapy.In conclusion, it may be benefit for decreasing incidence of arrhythmia if we select the patients following the standard indications strictly, shorten procedure time and choose the suitable type of VSD occluder. The HRV parameters might be a good and objective method to assess the cardiac function of the patients with VSD occlusion.