偏心或对称型室间隔缺损封堵器对介入封堵术后心电生理的影响

目的通过对心电监护、心电图及动态心电图分析，评价应用偏心或对称型室间隔缺损封堵器治疗先天性膜周部室间隔缺损后对早期心电生理的影响。方法123例膜周部室间隔缺损患者，偏心封堵器治疗56例，对称封堵器治疗67例。患者术前、术后行心电图及动态心电图检查，术中、术后行心电监护，对数据进行统计分析。结果（1）心导管资料及介入治疗结果：手术成功率，平均肺动脉压（mmHg），Qp／Qs，室间隔缺损直径（cm），距主动脉瓣距离（cm），封堵器直径（cm），手术时间（min），X线曝光时间（min）两组比较未见明显差异。（2）心电图及Holter结果：两组内经连续变量配对t检验后，术后室性早博数目增加有显著性差异（P=0．03），室上性早博增加不显著（P=0．05），PR间期、QRS宽度、QTc术前术后无显著性差异；两组间经χ^2检验，平均心率（Ha），豫间期，QRS波宽度，校正QT间期（QTc），房室交界区早搏（AVE），室性早搏（vr），非阵发性交界性心动过速（NPJT），非阵发性室性心动过速（NpVT），房室传导阻滞（AVB）和束支传导阻滞（BBB）均未见显著差异；独立变量与室性早博的线性回归分析提示年龄与室性早博数目的增加相关（P=0．02），而体重、性别、室缺大小、封堵器直径与室性早搏无关。结论经导管堵闭膜周部室间隔缺损术后，室性早搏数目明显增加并出现加速性交界性和室性自主心律；但更应防止术后高度房室传导阻滞的发生及其带来的危害，加强患者的术后心电监护。

Arrhythmia associated with transcatheter closure of primembranous ventricular septal defects using the asymmetry and symmetry septal occluder device

Objective The aim of this study was to prospectively assess the early arrhythmia after transcatheter closure （TCC） of perimembranous ventricular septal defects （VSD） using the asymmetry and symmetry septal occluder device made in China. Methods From 6/2003 to 1/2008, 123 patients with perimembranous ventricular septal defects, underwent TCC using the device at a median age of 13. 1 years （1.3-40. 0 years） and median weight of 39. 9 kg （ 11.0-89. 0 kg）. ECG and Ambulatory Holter monitoring was performed pre-procedure. ECG and Ambulatory Holter monitoring and Ambulatory ECG monitoring was performed post-procedure. EGG and Holter analysis included heart rate （HR）, PR interval, QRS duration, QTc, supraventricular ectopy （ SVE ）, ventfieular ectopy （ VE ）, junctional tachycardia, ventricular tachycardia, and conduction defects including arterial-ventricular block and bundle branch block. Results （ 1 ） Catheterization material and interventional treatment results ： surgical success, mean pulmonary artery pressure （mm Hg）, and lack of Qp/Qs diameter （ cm ）, is apart from the aortic distance （cm ）, occluder diameter （ cm）, the operation time （ min ）, X-ray exposure time （min） two groups of comparisons nonsignificant between-group. （ 2 ） A significant increase in post-closure number of VE （ P = 0. 03 ） was noted. There is no significant difference before and after procedure in SVE change （P = 0. 05 ）, PR interval,QRS duration, or QTe. Between the two groups χ^2 test, the average rate （HR） , PR interval, QRS wave width, calibration QT interphase QTc （ atrioventricular junction area） , AVE, ventricular premature beat （ VE ） , the border tachycardia （ SNRT NPJT ） , the NPVT ventrieular taehycardia （ paroxysmal atrloventrlcular） , and there were no a significant difference in conduction block. Independent variables and ventricular premature beat useing the linear regression analysis ： the increase of age and early number ventricular premature beat （ P = 0.02 ） , and weight, gender, chamber of occluder diameter and ventricular size or number of bo changes of earlier. Conclusions After transeatheter closure, the patient significantly increased the number of ventricular premature beat and accelerated border and ventricular arrhythmia independently, but we should prevent postoperative highly atrioventricular block occurrence and the harm, strengthen the postoperative patients ECG monitoring.