实时心电监测在室间隔缺损堵闭术中的应用

目的探讨实时心电监测在室间隔缺损（VSD）堵闭治疗中的应用价值。方法 65例均经左室造影证实为VSD者接受堵闭术治疗,并选手术前心电图检查基本正常者为研究对象。在堵闭术中及术后3～5d予实时心电监测,观察有无心律失常尤其是恶性心律失常的发生,并据此及时对应治疗甚至终止手术。随后跟踪随访心电情况1年。结果 65例在术中或术后发生心律失常事件13例,发生率20%。其中6例在建立股动静脉轨道过程中,出现三度房室阻滞（AVB）2例、完全性左束支阻滞（CLBBB）2例、CLBBB并三度AVB 1例、室性心动过速（VT）1例。评估术后可能发生严重并发症的风险后放弃堵闭。另7例心律失常中5例术中出现完全性右束支阻滞（CRBBB）或一过性不完全性右束支阻滞（ICRBBB）,于堵闭器释放后均自行恢复正常;2例术后出现三度AVB伴短阵VT或ICLBBB,及时应用激素治疗2～3d后心律失常消失。跟踪随访期未见异常。结论在VSD堵闭治疗中,心律失常的发生率较高。实时心电监测可及时发现术中、术后心律失常的发生,并指导临床治疗。

Application of real-time electrocardiogram monitor in occlusion of ventricular septal defect

Objective To evaluate the use of real-time electrocardiogram（ECG） monitor in transcatheter occlusion of ventricular septal defect（VSD）.Methods 65 patients including 3 residual VSD after surgical repair and 62 membranous ventricular septal defect were performed transcatheter occlusion in Children＇s Hospital of Fudan University from 2002 to 2008.Real-time ECG（GE Prucka CardioLab 4000 workstation） monitor was routinely used during the procedure.Results All VSD cases were confirmed by left ventricle angiogram.Arrhythmia happened in 13 of 65 cases（20%） during or after the operation.The occlusion failed in 6 cases due to recurrent severe arrhythmia detected by real-time ECG monitor when established the femoral A-V wire-track：Ⅲ degree atrioventricular bundle block（Ⅲ° AVB）,complete left bundle branch block（CLBBB）,Ⅲ？AVB combined with CLBBB,and intraventricular block combined with ventricular tachycardia（VT）in 2,2,1 and 1 case,which may result in persistent arrhythmia after occlusion.Arrhythmia were detected in 7 of 59 cases（90.7%） with successful occlusion：4 cases had complete right bundle branch block（CRBBB）and recovered after releasing the occluder,3 cases had transient incomplete right bundle branch block（ICRBBB）when the A-V wire-track was established,then followed with Ⅲ° AVB with non-persistent ventricular tachycardia（VT）or CLBBB after the occlusion,in which the arrhythmia disappeared in 2～3 days with steroid therapy.Conclusion The prevalence of arrhythmia is much higher in transcatheter closure of VSD than that in other interventional procedures.Real-time ECG monitor is valuable in detecting arrhythmia during and after the occlusion.