室间隔封堵术后215例心电图分析

Changes in electrocardiographics of 215 patients after transcatheter closure of ventricular septal defect

目的探讨经导管介入治疗室间隔缺损(VSD)后,心电图变化的特点。方法选择2002年8月至2004年12月在第四军医大学西京医院进行VSD介入治疗的215例患者(其中膜周部VSD175例、嵴内型11例、嵴下型24例、肌型5例),连续观察心电图变化。结果患者术前心电图均正常;术后137名患者心电图正常,78名患者心电图异常。78例心电图异常者中17名患者出现干扰性房室脱节,最晚第5天恢复正常;17名患者出现左前分支传导阻滞,除2名未恢复外,其余均恢复正常;22例出现右束支传导阻滞或左束支传导阻滞,直至出院未恢复;11例出现完全右束支传导阻滞+左前分支传导阻滞,其中7例发生高度房室传导阻滞;11例出现高度或Ⅲ度房室传导阻滞,9例恢复窦性心律,2例未能恢复,最后植入心脏起搏器。嵴下型VSD病例中有1例发生房室传导阻滞。结论VSD介入治疗影响了心脏的传导系统,多数患者可恢复到正常,少数患者将遗留严重并发症。

Objective To explore the characteristics of electrocardiographic （ECG） changes after transcatheter closure of ventricular septal defect （VSD）. Methods Changes in ECGs of 215 patients after transeatheter closure of VSD from 2002 to 2004 were studied. Results The ECGs of all 215 patients were normal before operation while after operation, ECGs remained normal in 137 patients but 78 patients turned out to be abnormal. Transient atrioventricular interference dissociation occurred in 17 patients and their ECGs recovered to normal after 5 days. Left anterior bundle branch block occurred in another 17 patients and 15 of them returned to normal state 6 days after the procedure. Either right bundle block or left one occurred in 22 patients and their ECGs remained abnormal until they were discharged from the hospital. Advanced or Ⅲ° atrioventricular block occurred in 11 patients, 9 of them returned to normal state, but 2 patients required pocemaker implantation. Conclusion Transcatheter closure of VSD interferes the cardiac conducting system. Most patients can restore normal state, but few may leave behind sequelce.