Atrioventricular Block: A Serious Complication in and After Transcatheter Closure of Perimembranous Ventricular Septal Defects

Abstract

Background: Transcatheter closure is an effective approach for perimembranous ventricular septal defects (PMVSD). However, atrioventricular blocks (AVB) emerged possibly due to the close proximity of the PMVSD to the conduction system, but concern for the complication was not adequately emphasized. In this study, we report the incidence of AVBs, in and after transcatheter closure of a PMVSD, and the outcome of the complication in our center. Methods: One hundred and sixty-eight PMVSD patients were accepted for transcatheter closure with Amplazter PMVSD occluder (AGA Medical, Plymouth, Minn., USA). The procedure was discontinued when a secondor third-degree AVB occurred. A steroid was administered to all patients who developed AVBs. Temporary pacemakers were inserted in patients who developed a complete AVB or Mobitz type II AVB during or after the procedure. Results: During the follow-up period of 6-24 mo (mean 10.6±3.9), the incidence of AVBs occurring during or after transcatheter closure of PMVSD was 3.5%. The AVB disappeared quickly after discontinuing the procedure in patients who developed AVBs during the procedure, whereas the AVBs disappeared between 2 and 21 d (mean 8.0±8.8) in the patients who developed AVBs after the procedure. However, complete right bundle branch block (CRBBB) was observed, and a transient complete AVB emerged after 8 mo in 1 case, incomplete right bundle branch block (IRBBB) in 1 case, and CRBBB and left anterior hemiblock (LAH) in 1 case. Conclusions:The AVB is a serious complication during and after transcathter closure of PMVSD. More attention should be paid to the complication, and multicentres are required to monitor the complication.

Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: A single-center experience on 1046 cases

“…Complete atrioventricular block (cAVB) is a rare but serious complication of the procedure. [4][5][6] Previous literature has described that cAVB can occur immediately or later after transcatheter occluder closure. [7][8][9] Since the exact mechanism of postoperative cAVB is not fully investigated, the occurrence of cAVB in patients treated with percutaneous interventions is unpredictable.…”

Acinetobacter Endocarditis Presenting as a Large Right Atrial Mass: An Atypical Presentation

“…7,8 Endocarditis as a complication of closure devices has also been reported. 9,10 This case report also highlights the diagnostic utility of TTE and TEE in real-time characterization of intracardiac masses, valvular abnormalities, and flow hemodynamics as well as guiding management. Three-dimensional TTE or biplane TEE are particularly useful in imaging the dimensions of masses that may be irregularly shaped more accurately than conventional two-dimensional echocardiography.…”

Percutaneous Closure of a Perimembranous Ventricular Septal Defect Through Arm Approach (Radial Artery and Basilic Vein)

“…9 Percutaneous approaches are becoming more common due to high technical success rates, low complication rates, lesser morbidity and preference of younger patients to avoid surgery, and the associated complications. [1][2][3][4][5][6][7] In a large European VSD registry of 430 patients, closure success rate was 95.3%, and mortality rate 0.2%. 4 Accessrelated complication for VSD closure ranges from 2% to 2.5%.…”

“…4 Accessrelated complication for VSD closure ranges from 2% to 2.5%. [1][2][3][4][5][6][7] The reported case shows the feasibility of closing a pmVSD by utilizing only RA and BV accesses.…”

“…[1][2][3][4][5] Though the incidence of heart block after closure of pmVSD has remained the most concerning complication (approximately 4-5%), little consideration is given to the access-related complications and access choices. 6,7 We report, to the best of our knowledge, the first ever pmVSD closure performed through radial artery (RA) and basilic vein (BV) access (arm access).…”