Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect

Abstract

Two patients with perimembranous ventricular septal defects (VSDs) and inlet extension have undergone uncomplicated transcatheter device closure using the Amplatzer membranous VSD device. Both patients developed complete heart block 2-4 days from the closure. Both patients responded well to high-dose intravenous therapy with steroids and high-dose oral anti-inflammatory aspirin. Both patients remain in normal sinus rhythm 8 weeks and 10 months, respectively, from the episode.

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

“…11 Some studies have reported the incidence of transient complete AVBs in up to 1%-5% of patients undergoing transcatheter device closure of a PMVSD. 6,12 In our study, the incidence of AVBs was 3.5%. The exact underlying mechanism of an AVB remains speculative, but the occurrence of an AVB in the procedure when the arteriovenous loop was created or the occluder deployed in the septum, suggests the system of conduction was injurious.…”

“…In the report of Walsh, 7 the permanent pacemakers were no longer being activated in all 3 patients who developed AVBs after the procedure, because their AVBs had disappeared. In the study of Yip,6 complete heart block also disappeared in both cases after highdosage steroid and aspirin were administered. In our study, atrioventricular conduction recovered after 21 d in 1 patient who refused to accept a permanent pacemaker.…”

“…High-dosage steroid and aspirin, both very powerful anti-inflammatory agents, may be useful in reversing AVBs, 6,15 but the effectiveness of these drugs has yet to be determined. In the surgical literature, 16 Clinical Investigations continued Abbreviations: AVB = atrioventricular block; CAVB = complete atrioventricular block; CRBBB = complete right bundle branch block; ICRBBB = incomplete right bundle branch block; LAH = left anterior hemiblock; VSD = ventricular septal defect.…”

“…1,2,5 However, the complication of atrioventricular block (AVB) emerged due to the close proximity of a PMVSD to the conduction system. 6,7 In this article, we report the incidence of AVBs during and after transcatheter closure of PMVSD with the Amplazter eccentric PMVSD occluder, and the outcome of the complication in our center.…”

Rhythm and conduction abnormalities after transcatheter closure of VSDs: A single-center experience

“…However, they are important since they progress to seconddegree AVBs (6,(8)(9)(10). In our study, second-degree II AVBs developed in two patients with bundle branch blocks (patients 4 and 7) in the follow-up period.…”