AIM To exploring the influencing factors of transcatheter closure of perimembranous ventricular septal defect (pmVSD) and postoperative arrhythmia in elderly individuals over 60 years old.

METHODS 59 patients over 60 years old who underwent successful interventional occlusion treatment at the Northern Theater Command General Hospital from January 2009 to June 2023 were selected. The immediate and 24-hour postoperative electrocardiogram and TTE, 2-7 day electrocardiogram, 1-3, 6, 12 months, and annual follow-up were used to evaluate the occlusion effect and incidence of complications, and to analyze the influencing factors for the occurrence of arrhythmia.

RESULTS  59 patients over 60 years old were selected, all of whom had pmVSD, and the intervention surgery was successful. 37 cases (63%) of postoperative arrhythmias occurred, except for the two cases of cAVB, 35 cases of other arrhythmias occurred, including 9 cases (15%) of sinus bradycardia; 1 case of complete right bundle branch block accompanied by 2 cases of I ° atrioventricular block (3%); 21 cases (36%) of premature ventricular and atrial contractions; Intermittent junctional rhythm in 2 cases (3%), and prolongation of ventricular bundle branch conduction in 1 case (2%). There were no statistically significant differences in gender, height, weight, symptoms, signs, history of infective endocarditis, NYHA grading, and comorbid membranous protrusion tumors between the postoperative arrhythmia group and the non postoperative arrhythmia group. The age of the postoperative arrhythmia group was higher than that of the non arrhythmia group (P<0.01), and the BSA was lower than that of the non arrhythmia group (P<0.05). There were no statistically significant differences in chest to heart ratio, echocardiography data, defect size, surgical time, exposure time, occluder size, and dVSD between the postoperative arrhythmia group and the non postoperative arrhythmia group. The dVSD/BSA of the postoperative arrhythmia group was higher than that of the non arrhythmia group (P<0.05). Multivariate regression showed that age (OR=1.723, 95% CI: 1.613~1.845, P<0.01) and dVSD/BSA (OR=1.231, 95% CI: 1.182~1.283, P<0.01) were independent influencing factors for the occurrence of arrhythmia in patients after pmVSD occlusion, while BSA was not its independent influencing factor. There was no difference in follow-up results between the postoperative arrhythmia group and the non postoperative arrhythmia group. All patients were followed up for at least 6 months after surgery, with a serious complication rate of 3%. During the follow-up period, there were no serious complications such as infective endocarditis, occluder embolism, or valve regurgitation requiring surgical treatment. TTE reexamination showed that residual shunts after occlusion were minimal or minimal, with an immediate postoperative incidence of 19%. No new tricuspid or aortic regurgitation was observed in all patients during follow-up. Two patients died 3 years and 6 years postoperatively (due to acute myocardial infarction and lung cancer), respectively. During the follow-up period, all 55 patients had a New York Heart Association (NYHA) grade I or II cardiac function.

CONCLUSION Elderly patients with pmVSD aged over 60 years have a higher risk of arrhythmia after transcatheter closure, but it is a relatively safe and effective treatment for strictly selected elderly patients. Strict preoperative interventional indications, intraoperative proper selection of occluders, and postoperative follow-up are important strategies to reduce complications.