室间隔缺损介入封堵治疗发生心律失常的临床研究

Clinical Study on the Occurrence of Arrhythmia after Transcatheter Closure of Ventricular Septal Defect.

目的探讨室间隔缺损(VSD)经导管介入治疗发生心律失常的机制及防治对策。方法对79例VSD患者进行介入封堵治疗。膜周部VSD单纯型50例,膨出瘤型28例,肌部VSD1例。选用Rashkind双伞闭合器2例,Sideris钮扣闭合装置16例,Amplatzer PDA封堵器45例,Amplatzer偏心型膜周部封堵器11例,Am-platzer肌部VSD封堵器1例。结果79例患者75例封堵成功(94.9%)。术后新出现心律失常31例(41.3%),其中不完全性右束支传导阻滞17例(22.7%),完全性右束支传导阻滞3例(4%),完全性左束支传导阻滞6例(8%),室性早搏3例(4%),间歇性室上性心动过速2例(2.7%)。1例患者术前心电图示完全性右束支传导阻滞,术后第4天心电图表现为Ⅲ度房室传导阻滞,临床伴发阿—斯综合征。经紧急开胸心脏挤压,气管插管,安置心外膜临时起搏器,复苏成功,出院时患者心电图恢复至术前状态。其余25例束支传导阻滞,其中5例应用强的松30mg/日,一周后仅有2例存在不完全性右束支传导阻滞,1例存在不完全性左束支传导阻滞。3例室性早搏,2例为一过性,1例经抗心律失常药物治疗,出院时室性早搏仍有591次/24小时。结论经导管封堵VSD,出现心律失常达41.3%,但严重心律失常发生率低,是安全、有效可靠的治疗方法。

Objective To study the mechanism of arrhythmia after transcatheter closure of ventricular septal defect （VSD） and discuss the countermeasure of treatment and prevention measure. Methods A retrospective analysis was performed on 79 VSD patients treated with transcatheter intervention. Among them, 50 eases were single perimembranous ventricular septal defects （PMVSDs） ,28 cases had aneurysm formation around the PMVSDs and one case was muscular ventricular septal defects. Amplatzer PDA occluder, Sideris buttoned device, Amplatzer asymmetric membranous septal defect occluder, Rashkind double umbrella device and Amplatzer muscular VSD occluder were used in 45, 16, 11, 2 and 1 case respectively. Echocardiography and ECG were performed for patient＇ s follow - up. Results The procedure was successful in 75 patients （94.9%）. 31 cases of them （41.3%） developed arrhythmia later which included 17 （22.7%） incomplete right bundle branch block（IRBBB）,3（4% ）complete RBBB, 6 （8%） complete left bundle branch block（CLBBB）, 3 （4%） premature ventricular beats and 2（2.7% ） paroxysmal supraventricular tachycardia. One patient with CRBBB before operation developed Ⅲ degree AV block complicating Adams- Stokes syndrome on the fourth day after closure. The patient recovered to pre - closure ardaythmias after successful anabiosis and temporary implantation of pacemaker. 5 patients with bundle branch block were treated with corticosteroids 30mg/d, only 2 of them remained IRBBB and 1 patient remained ILBBB after a week. 2 cases of the premature ventficular beats were just transient and the other case still had 591 beats/24 hours after treated with antiarrhythmia drugs. Conclusions The low rate of arrhythmia suggests that transcatheter closure of VSD is a safe, effective and dependable treatment.