膜周部室间隔缺损介入封堵术后心律失常危险因素及转归分析

Postprocedural outcomes and risk factors for arrhythmias after catheter intervention of perimembranous ventricular septal defect

目的探讨膜周部室间隔缺损(PmVSD)介入封堵术后心律失常的危险因素和转归。方法选择2019年1月至2021年2月在安徽省儿童医院心内科行PmVSD介入封堵术69例患儿为研究对象,回顾性分析患儿的临床资料、心电图和/或动态心电图、经胸超声心动图、术中心导管检查以及术后随访资料,按照是否发生心律失常,分为心律失常组(n=9)与非心律失常组(n=60),采用多因素logistic回归分析PmVSD介入封堵术后心律失常的危险因素。结果心律失常组患儿QRS间期为109.00(93.50,127.50)ms,非心律失常组患儿QRS间期为74.00(71.25,78.00)ms,两组差异有统计学意义(P<0.05)。两组患儿缺损直径、肺循环/体循环血流量比值(Qp/Qs)和曝光时间进行比较,差异有统计学意义(P<0.05),多因素logistic回归分析显示,曝光时间延长是PmVSD介入封堵术后心律失常发生的危险因素(OR=1.416,95%CI:1.120~1.790,P<0.05)。随访12.00(6.00,12.00)个月,7例(包括2例严重心律失常)心律失常患儿恢复窦性心律。结论PmVSD介入封堵术后心律失常以束支传导阻滞多见,大部分术后早期可恢复正常,曝光时间延长可增加PmVSD封堵术后心律失常的发生。

Objective To explore the outcomes and risk factors of arrhythmias with transcatheter device closure of perimembranous ventricular septal defect(pmVSD).Methods From January 2019 to February 2021,the clinical data of 69 pmVSD patients in Anhui Provincial Children’s Hospital were retrospectively reviewed.Electrocardiogram and/or holter,transthoracic echocardiography(TTE),cardiac catheterization data before and after the procedure were collected and analyzed.We compared the potential risk factors between arrhythmia group(9 cases)and nonarrhythmia group(60 cases)using univariate analysis,followed by logistic analysis for independent risk factors.Results QRS durations were 109.00(93.50,127.50)ms in arrhythmia group and QRS durations were 74.00(71.25,78.00)ms in nonarrhythmia group,and the difference between them was statistically significant(P<0.05).Single factor analysis showed that defect diameter,pulmonary to systemic flow ratio(Qp/Qs)and fluoroscopy time had significant differences between two groups(P<0.05).Logistic regression analysis revealed that increased fluoroscopy time was a risk factor for pmVSD postprocedural arrhythmias(OR=1.416,95%CI:1.120~1.790,P<0.05).On a median followup of12.00(6.00,12.00)months,7 arrhythmias patients(including 2 severe arrhythmias)reverted to normal heart rhythm.Conclusions The outcomes of patients with arrhythmias,especially with bundle branch block after transcatheter closure of pmVSD arecommon and can achieve early recovery.The long fluoroscopy time mayincrease the risk of arrhythmias after catheter intervention.