室间隔缺损经导管封堵术围术期心律失常的防治

The prevention and treatment of arrhythmia during the transcatheter closure of ventricular septal defect

目的探讨室间隔缺损(VSD)经导管封堵术围术期心律失常的发生率、可能原因及防治措施。方法选择2002年10月至2006年12月在我科住院并成功接受经导管封堵术的232例VSD患者为研究对象,分别于封堵术前、术后1～4天记录常规心电图及24h动态心电图,术中持续心电监护,由心电专业人员进行分析,得出各型心律失常检出率。结果232例VSD患者术后心律失常检出率明显增加(26.3%vs13.4%,P<0.01);术后新发束支传导阻滞与房室传导阻滞(AVB)27例,8例AVB患者中5例为迟发性Ⅲ度AVB。经用大剂量激素等治疗恢复正常。VSD封堵术后新发传导阻滞的27例患者VSD与封堵器差值较对照组(n=27)明显大(2.94±0.92mmvs1.94±0.69mm,P<0.01)。结论VSD封堵术后新发生的心律失常以心脏传导阻滞为主,所选用封堵器偏大可能是其原因之一;激素治疗有效,预后一般良好。

Objective To summarize the revalence, causes, prevention and treatment of arrhythmia during transcatheter closure of ventricular septal defect（VSD）, Methods Two hundreds thirty two cases accepting successful transcatheter closure from Oct, 2002 to Nov, 2006 were analyzed. 12 leads ECG and 24-hour record of Holter were taken before and 1 - 4 days after transcatheter closure. The results were automatically analyzed by computer and then reviewed by professional electrocardiogram technician. Results 13,4 percent of patients had different kinds of arrhythmia before transcatheter closure in 232 cases. The arrhythmia was significantly increased post-closure（26.3% ） , bundle branch block and atrioventricular block （AVB） were detected in 27 patients for the first time. 5 of 8 patients with AVB had retarded Ⅲ°atrioventricular block and they recovered by hormone treatment. Compared with the control group, the difference between the diameters of occluders and the measured values of VSD was significantly increased（2. 94 ± 0.92 mm vs 1.94 ± 0.69 mm, p 〈 0.01 ）. Conclusion The block of conduction is the core feature in the new arrhythmias, and the bigger occluder maybe one of the reasons. The hormone treatment is effective and its prognosis is commonly satisfied. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2007,21 （3） ：212 -214]