| [Objective]The most common arrhythmias after interventional treatment of ventricular septal defect(VSD),and some arrhythmias such as ? degree or ?degree atrioventricular block.complete left bundle branch block not only affects the quality of life of patients,even the patient's heart function has a different degree of influence,the most serious may endanger the lives of patients,so the purpose of this study is to investigate the related factors of interventional arrhythmia.[Method]Collected in the First Affiliated Hospital of Kunming Medical University from October 2015 to December 2017,and confirmed 55 patients with ventricular septal defect by transthoracic echocardiography(TTE)and ventricular angiography.In two cases,the defect was too small and the attempt to plug was unsuccessful.A family member was reluctant to take the risk to give up the interventional treatment.The remaining 52 patients met the indications for interventional treatment and successfully implanted 52 occluders.The hospital patient records were selected from 52 patients successfully implanted with an occluder.The basic data of the patients were included:patient age,gender,preoperative,postoperative and discharge electrocardiograms.The TTE measured cardiac-related data.The surgical data included the operation time,occluder material,left ventricular angiography to determine the size of VSD defect and its treatment after surgery.Including 21 males and 31 females,aged 3 to 64 years,mean age(17.69±4.91)years old.The diameter of the left side of the VSD measured by TTE was 4.3 to 13.8(9.51±0.68)mm,and the right side was 3 to 12.7(7.18±0.73)mm.Left ventricular angiography was used to reconfirm and measure the size of the defect.The left ventricular surface was 4.5-18(9.76±0.86)mm,the right ventricular surface was 3.5-15(7.25±0.82)mm,and the operation time was 35-130(73.51 ±7.82)minutes.Occluder size 5 to 16(9.41 ±0.77)mm.17 patients with bulge tumor VSD.All patients were made with domestic occluders,among which 46 were symmetric occluders,and other occluders(small waist,large,eccentric)were 6.Interventional treatment of patients using standard reference "Common congenital heart disease intervention in China expert consensus 2" Ventricular septal defect interventional therapy.Exclusion criteria:1.Ventricular septal perforation after myocardial infarction;2.Ventricular septal perforation after trauma;3.VSD with severe pulmonary hypertension with bidirectional shunt;4.VSD with other types of congenital heart disease.This study is a retrospective analysis of the patient's age.gender,operative time,defect size,preoperative electrocardiogram,whether the membrane defect,the size of the occluder and occluder type,whether there are such factors as bulging tumors Logistic Regression Analysis Using SPSS20.0.The chi-square test was used to compare the incidence of postoperative arrhythmia with the count data after the grouping of variables,and the discrepancies were grouped and compared between groups for analysis of variance.Statistical results were statistically significant(P<0.05).[Result]In this study,transient VTR and ventricular contractions occurred in 92.3%(48/52)of 52 VSD patients successfully treated with occlusion.Postoperatively,arrhythmia occurred in 24 patients.46.2%(24/52).A total of 22 new arrhythmias occurred within 24 hours after surgery.The new rate was 42.3%(22/52).The other two patients had sinus tachycardia and complete right bundle branch block before surgery(CRBBB).still exists after surgery.Electrocardiographic findings 24 hours after operation:8 cases of left anterior fascicular block(LAFB),3 cases of CRBBB,2 cases of incomplete right bundle branch block(ICRBBB),1 case LAFB combined with ICRBBB with atrial fibrillation,1 case with ICRBBB with I degree AVB,4 cases with sinus tachycardia,2 cases with ventricular premature beats with LAFB,1 case with intraventricular transmission block.1 case with sinus bradycardia and no arrhythmia Qi,1 case of sinus bradycardia.(1)Age group:Incidence of postoperative arrhythmia in the group of patients younger than 10 years and in the group of patients 10 to 20 years old and 20 years or older,respectively,The difference was statistically significant(P<0.05),The incidence of postoperative arrhythmia in patients younger than 10 years was significantly higher than that in patients 10 to 20 years old and those over 20 years old;There was no significant difference between the 10 to 20 year old group and the 20+ year old group(P>0.05).(2)Surgical time group:The incidence of arrhythmia after operation was greater than 100 minutes in the group and the operation time was less than 60 minutes,and the operation was in the 60-100 minutes group.The difference was statistically significant(P<0.05).The incidence of postoperative arrhythmia was significantly higher in the operative time greater than 100 minutes group than in the operative time less than 60 minutes group and in the 60 to 100 minutes group,the operative time was less than 60 minutes and the operation was in the 60 to 100 minutes group.The incidence of postoperative arrhythmia was not statistically different(P>0.05).(3)Defective size group:The incidence of arrhythmia in the patient group with the defect above 10mm and the patient group with the defect below 6mm and the defect group between 6 and 10mm were significantly different(P<0.05),the incidence of postoperative arrhythmia was significantly higher in the defect group above 10mm than in the patient group below 6mm and the defect group between 6-10mm,the incidence of arrhythmia was not statistically different between patients with 6 mm or less defect group and 6-10 mm defect group(P>0.05).(4)Occluder diameter group:The incidence of arrhythmia was significantly different between patients with occluder diameter above 10 mm and patients with occluder diameter below 6 mm and occluder diameter between 6 and 10 mm.There was a statistically significant difference(P<0.05).),The incidence of postoperative arrhythmia in patients with occluder over 10 mm was significantly higher than that of patients with occluder diameter below 6 mm and occluder diameter between 6-10 mm;occluder diameter was less than 6 mm.The incidence of postoperative arrhythmia in patients with occluder diameter between 6 and 10 mm was not statistically different(P>0.05).(5)The incidence of postoperative arrhythmia was significantly different between the membrane VSD and other types of VSD(P<0.05).The rate of arrhythmia after VSD in the membrane was higher than that of other types of VSD.The incidence of postoperative arrhythmia after preoperative electrocardiogram abnormalities was compared(P>0.05),and the difference was not statistically significant.The incidence of arrhythmia after different types of VSD combined with bulging tumors was compared(P>0.05),and the difference was not statistically significant.The incidence of arrhythmia after commissural bulge in patients with ventricular septal defect was compared(P>0.05),and the difference was not statistically significant.According to the comparison of the incidence of arrhythmia after occluder type grouping(P>0.05),the difference was not statistically significant.(6)Age,occluder size,duration of operation,and defect size were related to arrhythmia after ventricular septal defect intervention.[Conclusion](1)Age,operative time,size of defect,diameter of occluder and incidence of postoperative arrhythmia were related,and age was negatively related to the occurrence of postoperative arrhythmia.Operative time,size of defect,size of occluder and incidence of postoperative arrhythmia Positive correlation.(2)The incidence of arrhythmia after ventricular septal defect surgery was higher than that of other types of ventricular septal defect.(3)The preoperative electrocardiogram positive abnormalities,bulging tumors,and occluder types are different from previous studies.Due to the small number of study cases,the sample size needs to be increased to further study and discuss. |
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