膜周部室间隔缺损介入治疗相关心律失常的发生与转归

李华康; 姚青; 郭燕丽; 周莲; 刘峰; 万陈; 黄海韵; 陈彦秀; 秦浩然; 文玲; 刘燕; 宋治远

doi:10.12125/j.chj.202106025

膜周部室间隔缺损介入治疗相关心律失常的发生与转归

Occurrence and outcome of arrhythmia related to interventional therapy for perimembranous ventricular septal defect

摘要

摘要:
目的探讨室间隔缺损(VSD)介入治疗相关心律失常的发生与转归。
方法以2002年10月～2019年5月在陆军军医大学第一附属医院住院并成功行VSD介入封堵术治疗的患者为研究对象，要求随访资料完整，分别统计患者术前及术后随访期间的心电图及动态心电图资料，随访方法为（1、3、6、12）个月各随访1次，以后每年随访1次。对VSD介入治疗相关性心律失常的发生及转归情况进行统计分析。
结果共筛选在我院行介入治疗VSD患者1125例，最终纳入794例（男，424例）膜周部VSD患者。所有患者均完成1年以上随访，随访时间(12.45 ± 4.70)年。结果显示：①VSD介入封堵术前心电图显示13例有心律失常（1.64%），包括频发房性早搏伴短阵房性心动过速3例、室性早搏4例、完全性右束支传导阻滞（CRBBB）6例。②VSD介入封堵术中及术后随访期间新发心律失常86例（10.83%），其中CRBBB 17例（2.14%）、不完全性右束支传导阻滞(IRBBB)20例（2.52%）、完全性左束支传导阻滞(CLBBB)17例（2.14%）、一度房室传导阻滞（AVB）4例（0.5%）、三度AVB12例（1.51%）、室性心律失常10例（1.26%）、室上性心律失常6例（0.76%）。③VSD介入治疗术中及术后住院期间新发心律失常84例，经治疗出院时74例完全恢复正常（88.10%）；至术后1个月随访时92.90%的患者完全恢复正常。④术后远期随访期间发生CLBBB及三度AVB各1例，其中三度AVB患者植入了永久性心脏起搏器。
结论 ①膜周部VSD介入治疗相关性心律失常发生率较高，但经积极治疗绝大多数可完全恢复正常。②VSD介入治疗后远期仍可发生严重心律失常，需引起临床重视。

Abstract:
AIM To explore the occurrence and the outcome of arrhythmia related to interventional therapy for ventricular septal defect (VSD).
METHODS VSD patients who were successfully treated with interventional therapy in our hospital and had complete follow-up data from October 2002 to May 2019 were selected as the research subjects. ECG and Holter data of the patients during the preoperative and postoperative follow-up period (1, 3, 6, 12 months respectively, followed up once a year) were counted. The occurrence and the outcome of VSD intervention related arrhythmia were analyzed.
RESULTS A total of 1125 VSD patients undergoing interventional therapy in our hospital were selected and 794 patients (424 males and 370 females) with perimembranous VSD were included for analysis. All patients were followed up for more than one year and the average follow-up time was (12.45 ± 4.70). The results showed that: Thirteen cases (1.64%) had arrhythmia before VSD interventional occlusion, including 3 cases of frequent atrial premature beat with short atrial tachycardia, 4 cases of ventricular premature beat and 6 cases of complete right bundle branch block (CRBBB). Eighty six patients (10.83%) had new arrhythmias during VSD occlusion and follow-up, including 17 cases (2.14%) of CRBBB, 20 cases (2.52%) of incomplete right bundle branch block (IRBBB), 17 cases (2.14%) of complete left bundle branch block (CLBBB), 4 cases (0.5%) of first degree atrioventricular block (AVB), 12 cases (1.51%) of third degree AVB, 10 cases (1.26%) of ventricular arrhythmia and 6 cases (0.76%) of supraventricular arrhythmia. Eighty-four cases of new arrhythmia occurred during and after VSD interventional therapy, of whom 74 cases (88.1%) recovered completely after treatment and 92.9% of whom returned to normal at 1 month follow-up. During the long-term follow-up, there were 1 case of CLBBB and 1 case of third degree AVB. Permanent pacemaker was implanted in the third degree AVB patient.
CONCLUSION The incidence of perimembranous VSD intervention related arrhythmias is high, but most of which can completely return to normal after active treatment. Severe arrhythmia can still occur long after VSD interventional therapy, which should attract clinical attention.

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