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Updated: Oct 11, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Risk factors for atrioventricular block after occlusion for perimembranous ventricular septal defect
Li Lin1, Jianwen Liu1, Xiufen Guo1
1Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
Insights
The ratio of device to defect size is the main risk factor for complete atrioventricular block (CAVB) after perimembranous ventricular septal defect (pmVSD) device closure. Device removal can restore normal conduction in some CAVB cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Complete atrioventricular block (CAVB) is a potential complication following device closure of perimembranous ventricular septal defects (pmVSD).
- The specific risk factors contributing to CAVB after pmVSD device closure are not well-established.
Purpose of the Study:
- To determine the incidence of CAVB after pmVSD device closure.
- To identify independent risk factors associated with the development of CAVB post-procedure.
Main Methods:
- A retrospective review of 1884 patients who underwent successful pmVSD device closure between June 2005 and January 2020.
- Permanent CAVB was defined as requiring permanent pacemaker (PPM) implantation or occluder extraction.
Main Results:
- The incidence of permanent CAVB was 0.7% (14/1884), with 0.5% (10/1884) requiring PPM implantation.
- The ratio of device to defect size was identified as the sole independent risk factor for permanent CAVB (OR 3.027; P = .003).
- Device removal was effective in restoring normal conduction in 80% of acute and subacute CAVB cases.
Conclusions:
- The incidence of permanent CAVB and PPM implantation after pmVSD device closure is low.
- A larger device-to-defect size ratio is a significant predictor of permanent CAVB.
- Device removal is a viable treatment option for acute and subacute CAVB, aiding in conduction recovery.
Background:
The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear.
Objective:
The purpose of this study was to analyze the incidence and risk factors for CAVB after device closure for pmVSD.
Methods:
We reviewed 1884 patients with pmVSD who had undergone successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of a permanent pacemaker (PPM) or extraction of the occluder.
Results:
In total, 14 patients (0.7%) developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVB occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio 3.027; 95% confidence interval 1.476-6.209; P = .003).
Conclusion:
The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.
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