Low Incidence of Rhythm Disturbance following Percutaneous Closure of Ventricular Septal Defects using the Amplatzer Device at Immediate-to-Long-Term Follow Up

Abstract

Background: There have been concerns of heart block and rhythm disturbances following transcatheter closure of VSD. Our aim in this study is to evaluate rhythm and conduction disturbances following percutaneous device closure of ventricular septal defects at immediate and long-term follow up. Methods: A retrospective review of all patients who underwent transcatheter VSD closure using an Amplatzer device from January 2003 to September 2012 at Hamad General Hospital in Qatar was performed, including catheterization data, echocardiograms, and EKGs at latest follow up. Results: Of 49 patients, 45 (35 perimembranous and 10 muscular) were successfully closed. Median age was 8.5 years and median weight was 24 kg. The median VSD size was 6 mm. Median pulmonary to systemic blood flow was 1.4:1, and the median Amplatzer device size was 8 mm. There was no immediate or late mortality, and the closure rate was 91.8%, whereas the procedure was unsuccessful or abandoned in 8.2% of cases. At a mean follow up of 54.5 months, echocardiography revealed complete ventricular septal defect closure in 41 (91%) patients, and 4 (9%) patients had a small residual shunt. An electrocardiography median follow up of 61.9 months revealed normal sinus rhythm in 37 (84%) cases, incomplete right bundle branch block in 1 (2%) case, complete right bundle branch block in 4 (8%) cases, and left bundle branch block in 2 (4%) study group cases. However, complete atrioventricular block was observed in one (2.9%) of the perimembranous VSD patients. Conclusions: Transcatheter closure of perimembranous and muscular ventricular septal defects is a safe and effective procedure. Rhythm disturbance at late follow up is comparable with surgical closure rhythm disturbances and is less frequent than previously found in some transcatheter closure reports.