封堵器治疗室间隔缺损并发心律失常与腔内传导参数的关系

Relationship of Arrhythmia and Electrical Parameters after Transcatheter Closure of Ventricular Septal Defect

目的探讨经导管封堵室间隔缺损(VSD)术围术期发生心律失常与腔内传导参数改变的关系.方法经导管封堵术的VSD患者50例,使用腔内电图观察封堵术前后腔内心电参数的变化与心律失常的关系.结果(1)与VSD封堵术前比较,术后随访期间共发生心律失常20例,其中束支传导阻滞16例,包括完左2例,完右4例,一过性三度房室传导阻滞(Ⅲ°AVB)1例,在随访中大多可恢复正常;(2)封堵术前、术后心腔内电图示:房室传导参数A-H、H-V值(75.10±14.34)ms vs(80.67±23.03)ms及(47.9±12.61)ms vs(50.07±15.23)ms,差异无统计学意义(P>0.05).结论 (1)经导管VSD封堵术后,部分患者出现新的心电改变,表现为1周内束支传导阻滞增多,但大多可恢复正常,预后良好;(2)术中发生A-H、H-V延长与术后出现各类缓慢心律失常无关;(3)心律失常是VSD封堵术常见的并发症,但严重心律失常发生率低,严格选择适应症,避免采用直径过大的封堵器是减少VSD封堵术后心律失常的有效措施.

Objective To study the ralationship of arrhythmias and heart electrical parameters changes after transcatheter closure of ventricular septal defect （VSD） .Method 50 patients had been successfully finnished the transcatheter closure of ventricular septal defect,and then we observed ralationship of arrhythmias and heart electrical parameters changes. Results （1） Compared with the situation of VSD occluder preoperative and postoperative, during follow-up there were 20 arrhythmia cases, including bundle branch block 16 cases, including the complete left bundle branch block 2 cases,complete right bundle branch block 4 cases,a transient third-degree trioventricular conduction block 1 case, most return to normal in the follow-up. 2 Intracavitary electrogram showed before and after transcatheter closure：A-V conduction parameters A-H,H-V value of （75.10 ± 14.34） ms vs （80.67±23.03） ms and （47.9±12.61） ms vs （50.07±15.23） ms,the difference was not statistically significant （ P〉0.05） . Conclusions （1） Some patients with new ECG changes after transcatheter closure of VSD, manifested as an increase in bundle branch block in a week, but most return to normal,the prognosis is good. （2） Intraoperative A-H,H-V extension is not related with with postoperative slow arrhythmia;（3） Arrhythmia is a common complication after VSD transcatheler closure, to strictly selecte indications,and to avoid too large diameter are the effective measures to reduce the arrhythmias after transcatheter closure of ventricular＆amp;nbsp;septal defect （VSD） .