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Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: A
Yuan Bai1, Xu-Dong Xu1, Chang-Yong Li1
1Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Insights
Complete atrioventricular block (cAVB) after ventricular septal defect (VSD) closure is rare but serious. Adults over 18 are more prone, and lifelong follow-up is recommended due to potential recurrence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Complete atrioventricular block (cAVB) is a rare complication of transcatheter closure for ventricular septal defect (VSD).
- This serious event is often underrecognized and warrants further investigation.
Purpose of the Study:
- To determine the incidence and predisposing factors of cAVB after VSD closure using a modified double-disk occluder (MDO).
Main Methods:
- 1046 patients with perimembranous VSD underwent percutaneous closure with MDO.
- Electrocardiography was monitored pre-procedure, within 1 week post-procedure, and annually thereafter.
- Baseline and procedural parameters were evaluated, comparing patients who required pacemakers with those who did not develop cAVB.
Main Results:
- cAVB occurred in 1.63% (17/1046) of patients, with 8 requiring permanent pacemaker implantation.
- Most cAVB events (14/17) occurred within 30 days post-procedure; 3 occurred after 1 year.
- Patients older than 18 years were significantly more prone to cAVB (P = .025).
Conclusions:
- The incidence of cAVB after transcatheter VSD closure is acceptable, with some cases resolving with treatment.
- Late cAVB (>1 year) presents challenges in restoring normal conduction.
- Lifelong follow-up with periodic electrocardiography is recommended due to the possibility of cAVB recurrence.
Background:
Complete atrioventricular block (cAVB) has been deemed a rare complication after transcatheter closure for ventricular septal defect (VSD). However, this serious event appears to be underrecognized and is worth being investigated further.
Objectives:
To determine the incidence and predisposing factors of cAVB associated with closure of VSD using a modified double-disk occluder (MDO).
Methods:
From December 21, 2001 to December 31, 2014, 1046 patients with perimembranous ventricular septal defect underwent percutaneous closure using the MDO. Electrocardiography was evaluated before the procedure, within 1 week after the procedure, and then at 1, 3, 6, and 12 months and every year thereafter. Other baseline and procedural parameters were also evaluated and a comparison between patients requiring pacemakers and those not suffering from cAVB was done.
Results:
cAVB occurred in 17 patients (1.63%) after the procedure. Of the 17 patients, 8 underwent permanent pacemaker (PPM) implantation. The cAVB occurred within 30 days after the procedure in 14 patients and after 1 year in 3 patients. In comparison patients aged ≤18 years, patients aged >18 years were more prone to cAVB (P = .025). Logistic regression revealed no significant parameter to predict later requirement for PPM.
Conclusions:
The incidence of cAVB after transcatheter closure of VSD was acceptable, as part of the cAVB population recovered after administration of corticosteroid and application of a temporary pacemaker. Late cAVB (>1 year) appears to make it more difficult to restore normal conduction block. Because of the recurrence of cAVB, life-long follow-up with periodic electrocardiography examination may be mandatory.
