Analysis Of Arrhythymia And Risk Factors In Children With VSD After Interventional Closure

ObjectiveTo investigate the risk factors of arrhythmia in children with ventricular septal defect(VSD)after percutenious device closure and the safety and efficacy of the treatment.MethodsWe retrospectively analyzed the clinical manifestations,electrocardiogram and / or dynamic electrocardiogram,transthoracic echocardiography(TTE)and other preoperative examinations in patients with VSD treated by percutenious device closure during January 2014 to December 2016 at the Affiliated Children’s Hospital of Chongqing Medical University,Intraoperative operation and ECG monitoring,and postoperative follow-up data.The postoperative arrhythmia and its risk factors were analyzed in children with successful occlusion.Results1.There were 381 patients with VSD treated by device occlusion in the Children’s Hospital of Chongqing Medical University from January 2014 to December 2016,male 186(48.8%),female 195(51.2%),age 1.2 months to 16 years old(3.6±2.0 years old).In this study,367 cases were successfully closed(96.3%),No deaths,14 cases hadn’t treated by interventional therapy because they were not suitability after angiography.2.There are 84 cases had arrhythmia in 367 cases successful closure,the incidence was 22.89%,including Heart block in 58 case(69%),such as IRBBB in 32 cases(38.1%),CRBBB in 8 cases(9.5%),CLBBB in 1 cases(1.19%),LAFB in 10 cases(11.9%);AVB in 6 cases,respectively,Ⅰ° AVB in 3 cases(3.57%),Ⅱ° AVB in 1 case(1.19%),CAVB in 1 case(1.19%),Ⅰ°AVB combined with intraventricular block in 1 case(1.19%);origin abnormal type of arrhythmia in 26 cases(31%),including AV junctional escape beats in 9 case(10.71%),frequent atrial premature beats in 7 case(8.33%),frequent ventricular premature beats in 3 case(3.57%),non-paroxysmal nodal tachycardia in 3 case(3.57%),wandering rhythm in 2 case(2.38%),junctional escape beats in 1 case(1.19%),non-paroxysmal nodal tachycardia combined with atrioventricular interference dissociation in 1 case(1.19%);severe arrhythmia in 3 cases(3.57%),including CAVB,Ⅱ° AVB and CLBBB in 1 case,respectively.3.The relative analysis study show that the incidence of arrhythmia in children with VSD after device closure is closely related to whether the patient with arrhythmia pre-closure,size of VSD,VSD occludder and so on(P <0.05).4.There are 36 cases with arrhythmia after device closure have returned to normal within one week(36 / 84,42.9%),but 48 cases have not disappeared.3 cases with severe arrhythmia treated with intravenous methylprednisolone and/or dexamethasone,albumin for 3-5 days have improved.Conclusion1.Arrhythmia is one of common complications of children with VSD treated by interventional occlusion.2.The relative analysis show that incidence of arrhythmia in children with VSD after device closure is closely associated with VSD of membranous tumor,VSD diameter,occluder diameter,time length of operation,and arrhythmia before operation.3.Most arrhythmia in children with VSD after interventional treatment can be recovered to normal if giving appropriate treatment.