【摘要】 目的观察及分析儿童室间隔缺损(VSD)封堵术后心律失常的中远期改变情况。方法回顾性分析2002年3月至2010年12月行VSD介入封堵术的1 071例患儿在术后第l、3、6、12个月及其后每年的门诊随访资料。结果1 071例患儿中,早期(术后1个月内)出现心律失常者272例(25.4%),主要包括房室传导阻滞(AVB)、束支传导阻滞、交界性心动过速、房性及室性心动过速、频发期前收缩等,其中Ⅱ度以上AVB及完全性左束支传导阻滞(CLBBB)等严重心律失常22例(2.1%),经治疗后均好转,无患儿需安装永久起搏器。在以后的随访中,平均随访时间(2.8±1.7)年(1~107个月),持续存在心律失常者161例(18.2%),主要为AVB和束支传导阻滞,其中严重心律失常10例(1.1%);4例迟发型AVB中3例在术后早期就已出现过AVB,1例患儿随访过程中复发CLBBB并出现左心室增大,最终因心功能衰竭死亡;4例患儿随访过程中植入永久起搏器。结论 VSD封堵术后早期出现AVB或CLBBB等严重心律失常的患儿在随访过程中复发可能性大;传导阻滞类心律失常随访过程中可出现复发或加重;心动过速、期前收缩等起源异常的心律失常随访过程中大多可恢复正常。更多还原

【Abstract】 Objective To observe and analyze the medium and long term follow-up data of arrhythmias after transcatheter closure of children with ventricular septal defect(VSD). Methods Retrospectively analyzed the clinical data of 1071 children with VSD, who successfully underwent transcatheter device closure, at l, 3, 6, 12 months and every year post procedure from March 2002 to December 2010. Results Of all 1071 children, 272 cases(25.4%) were observed of having arrhythmias within 1 month after intervention, mainly including atrioventricular block(AVB), branch block, junctional tachycardia, atrial and ventricular tachycardia, frequent contractions, etc. Among them, 22 cases(2.1%) had above II degree AVB, complete left bundle branch block(CLBBB) and other causes of serious arrhythmias. After treatment, all cases got better and no permanent pacemaker was necessary. After 1 to 107 months(2.8±1.7 years) follow-up, 161 cases(18.2%) were observed of having persistent abnormal ECG mainly caused by AVB and branch block, including 10 cases(1.1%) with serious arrhythmias. In 4 cases with late-onset AVB, 3 cases had already appeared AVB in early postoperative, 1 case had recurrence CLBBB, left ventricle enlarge, and died of heart failure during follow up. Four cases were implanted permanent pacemaker. Conclusion During follow-up, serious arrhythmias after VSD closure, such as AVB or CLBBB, have high risk of recurring. Conduction block arrhythmias may reappear or worsen, while arrhythmias like tachycardia and premature heart rhythm mostly return to normal.更多还原