Predictors and long-term outcomes of heart block after transcatheter device closure of perimembranous ventricular septal defect

Abstract

BackgroundHeart block is the most common and concerning complication associated with transcatheter device closure of perimembranous ventricular septal defect (pmVSD) and its occurrence remains a great challenge for device closure.MethodsBetween June 2002 and June 2020, 1076 pediatric patients with pmVSD, who successfully underwent transcatheter device closure in our center, were enrolled in this cohort study, with a median follow-up of 64 months (range: 1 to 19 years).ResultsOf 1076 patients, 234 (21.8%) developed postprocedural heart block, with right bundle branch block being the most common (74.8%), followed by left bundle branch block (16.2%), and atrioventricular block (5.6%). Complete atrioventricular block occurred in 5 cases, including 3 cases with permanent pacemaker implantation, 1 case with recovery to normal sinus rhythm, and 1 case with sudden cardiac death. Most patients (97.9%) developed heart block within 1 week of procedure. Finally, 138 cases returned to normal cardiac conduction. Multivariate logistic regression revealed that thin-waist occluders (odds ratio [OR]: 1.759; 95% confidence interval [CI]: 1.023 to 3.022; P = 0.041), and oversized devices (OR: 1.809; 95% CI: 1.322 to 2.476; P < 0.001) were independently associated with occurrence of postprocedural heart block. Moreover, heart block was less likely to occur when the left disk of occluder was placed within the aneurysmal tissue (OR: 0.568; 95% CI: 0.348 to 0.928; P = 0.024).ConclusionThe outcome of postprocedural heart block is favorable in most cases. Oversized devices and thin-waist occluders should be avoided. Placement of the left disk of the device should into the aneurysmal tissue is highly recommended.

Risk Factors and Outcomes of Complete Heart Block in Children after Surgical Closure of Ventricular Septal Defects: The Role of Pacemaker Therapy

“…Regarding VSD type, our data was consistent with almost all the previously published studies [28][29][30]. Device size as an independent predictor of postprocedural CHB was additionally verified by a similar multivariate logistic regression evaluation that was conducted by Jiang et al [31]. However, the latter study also illustrated that type of the device, particularly the thin waist occlude, was a stand-alone risk factor for the development of postoperative heart block.…”

Transcatheter closure of ventricular septal defects by exclusive transvenous antegrade cannulation from the right ventricle

“…This was not significantly higher compared to the incidence ranging from 21.8% to 35.7% from the studies that meticulously identified all post-procedural arrhythmias. [28][29][30] Left anterior hemiblock was the most common abnormality similar to the experience from other studies. [31] As the surgical anatomy identified the conduction system to be closer to the LV side of the defect than the RV side, a transvenous antegrade cannulation from the RV end might not increase the possibility of post-procedural complications.…”