介入治疗膜周部室间隔缺损术后传导阻滞的危险因素再分析

Reanalysis of risk factors of post-procedure heart blocks after transcatheter closure of perimembranous ventricular septal defect

目的:在前期总结的膜周部室间隔缺损(perimembranous ventricularseptal defect,pmVSD)介入治疗策略指导下,观察后续pmVSD介入封堵术后传导阻滞发生状况,分析其危险因素和预防措施。方法:分析2012年1月—2020年7月间成功接受介入封堵的196例pmVSD患者术后发生传导阻滞的情况,采用Logistic单因素和多因素回归模型进行危险因素分析和探索。结果:术后新发传导阻滞18例(18/196,9.2%),包括完全性和不完全性右束支传导阻滞、左前分支传导阻滞、室内传导阻滞和Ⅰ度房室传导阻滞,未发生完全性左束支传导阻滞及高度房室传导阻滞,所有术后传导阻滞均在2个月内恢复。基底封堵组传导阻滞发生率(12.7%,17/134)较瘤内封堵组(1.6%,1/62)更高(P=0.014)。在基底封堵亚组,pmVSD上缘与主动脉瓣右冠瓣的距离(distance from the aortic valve to the defect,DAVD)越长(P=0.015)、破口直径越大(P=0.022),术后发生传导阻滞的风险越大。结论:基底封堵组传导阻滞发生率较高。在基底封堵组,DAVD及破口直径是术后传导阻滞发生的独立影响因素。

Objective:This study aims to observe the condition of post-procedure heart blocks after transcatheter closure of perimembranous ventricular septal defect(pmVSD)under the guidance of the new treatment strategy of transcatheter closure of pmVSD based on previous experience.To investigate the risk factors and prevent post-procedure heart blocks.Methods:The clinical data of the 196 patients who successfully underwent transcatheter closure of pmVSD from January 2012 to July 2020 were analyzed.Univariate and multivariate logistic regression models were used to analyze and explore the risk factors.Results:Total 18 patients(18/196,9.2%)developed post-procedure heart blocks,including complete and incomplete right bundle branch block,left anterior fascicular block,intraventricular block and first degree atrioventricular block.No complete left bundle branch block and high-degree atrioventricular block occurred.All post-procedure heart blocks recovered within 2 months.The incidence of heart blocks in the basal occlusion group(12.7%,17/134)was higher than the intratumoral occlusion group(1.6%,1/62)(P=0.014).The analysis of basal occlusion group showed that distance from the aortic valve to the defect(DAVD)(P=0.015)and the diameter of the defect(P=0.022)were positively related to post-procedure heart blocks.Conclusion:The incidence of heart blocks is higher in the basal occlusion group.In the basal occlusion group,DAVD and the diameter of the defect are independent risk factors of post-procedure heart blocks.