Prevalence and risk factors of arrhythmias after transcatheter closure of ventricular septal defect in children.

Qinghua Zhong; Hongyan Zheng; Zhiwei Zhang; Mingyang Qian; Yumei Xie; Shushui Wang

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Prevalence and risk factors of arrhythmias after transcatheter closure of ventricular septal defect in children.

Author: Qinghua ZHONG ¹ ; Hongyan ZHENG ¹ ; Zhiwei ZHANG ² ; Mingyang QIAN ¹ ; Yumei XIE ¹ ; Shushui WANG ¹
Author Information

1. Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China.
2. Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China. Email:drzhangzw@sohu.com.
Publication Type:Journal Article
MeSH: Arrhythmias, Cardiac; epidemiology; Atrioventricular Block; Body Weight; Cardiac Catheterization; Child; Child, Preschool; Electrocardiography; Female; Heart Septal Defects, Ventricular; epidemiology; Hospitals; Humans; Male; Prevalence; Protective Factors; Retrospective Studies; Risk Factors
From: Chinese Journal of Cardiology 2014;42(10):840-845
CountryChina
Language:Chinese
Abstract:
OBJECTIVETo evaluate the prevalence and risk factors of arrhythmia after transcatheter closure of ventricular septal defect (VSD) in children.
METHODSA total 1 069 children (583 males, mean age (7.7 ± 3.6) years) underwent transcatheter closure of VSD from January 2002 to December 2010 in our hospital were enrolled and retrospectively analyzed.VSD diameters were (4.0 ± 1.8)mm, 336 cases accompanied membranous aneurysm. Electrocardiogram were performed at 1, 3 days after the procedure.Once arrhythmias recorded, electrocardiogram was performed daily till discharge. All cases were followed up by ECG at 1, 3, 6, 12 months after the procedure in outpatient department and then in a year interval. The risk factors were identified by multivariable logistical analysis.
RESULTSAll VSDs were closed successfully and the diameters of occluder was (7.2 ± 2.1)mm. The median follow-up time was 2.2 (1.0-4.2) years. Mortality was zero during follow up.Incidence of early ( < 1 month) post-procedure arrhythmias was 24.6 % (263 cases), and severe arrhythmias were recorded in 50 cases (4.7%). There were 43 late ( ≥ 1 month) post-procedure arrhythmias (4.0%) including 4 (0.4%) complete atrioventricular block. Multivariable logistic analysis revealed that VSD treated with thin-waist-big-side occluder (OR = 2.426, 95%CI:1.835-3.208, P < 0.001) , male gender (OR = 1.267, 95%CI:1.055-1.523, P = 0.011) were the risk factors while higher body weight (OR = 0.838, 95%CI:0.737-0.951, P = 0.006) was protective factor for early onset arrhythmia. Placement of asymmetrical occluder (OR = 4.777, 95%CI:2.079-10.978, P < 0.001) , longer procedure time (OR = 1.011, 95%CI:1.002-1.020, P = 0.012) , occluder from foreign countries (OR = 2.621, 95%CI:1.143-6.014, P = 0.021) were the risks factors for early onset severe conduct block. Treatment with thin-waist-big-side occluder (OR = 2.654, 95%CI: 1.042-6.760, P = 0.041) was the risk factor while higher body weight (OR = 0.373, 95%CI:0.159-0.875, P = 0.023) was a protective factor for late onset conduct block.
CONCLUSIONSArrhythmia after transcatheter closure of VSD is common in children, and late onset severe conduct block is rare. The weight of patients should not too light and symmetrical occluder should be chosen if possible in the transcatheter closure VSD procedure to minimize the risk of late onset conduct block.