小儿经皮室间隔缺损封堵术后非阵发性 室性心动过速临床意义分析

目的　总结小儿经皮室间隔缺损（VSD）封堵术后非阵发性室性心动过速（AIVR）的发生情况，探讨其临床意义及可能的发生机制。方法　2002年10月至2011年5月，1179例VSD患儿在广东省心血管病研究所心儿科行经皮VSD封堵术（室缺封堵组），术后检出AIVR 17例。在我院门诊进行动态心电图检查的1392例非介入治疗患儿（非介入组）以及在我院行房间隔缺损封堵术的患儿988例（房缺封堵组）作为对照。比较室缺封堵组与对照组间AIVR的检出情况。对室缺封堵组9例患儿进行治疗，并对17例患儿进行随访。结果　室缺封堵组术后动态心电图AIVR检出率高于非介入组，差异有统计学意义（P < 0.05）；次日常规心电图AIVR检出率高于房缺封堵组（P < 0.05）。室缺封堵组所有AIVR患儿封堵术后1个月动态心电图均无AIVR，随访中无不良事件发生，随访心电图无AIVR。结论　室缺封堵组封堵术后AIVR检出率高于对照组，其发生与VSD封堵有关。该病多无自觉症状，预后良好，可能无须治疗。

Accelerated idioventricular rhythm after percutaneous transcatheter closure of ventricular septal defect in children.

Objective　To summarize incidence rate，clinical significance and mechanism of accelerated idioventricular rhythm （AIVR） after transcatheter closure of ventricular septal defect（VSD） in children. Methods　From Oct.2002 to May 2011，1179 children with VSD underwent percutaneous transcatheter closure. All patients received electrocardiogram and 24h dynamic electrocardiogram after transcatheter closure. Totally 1392 outpatients that received 24 h dynamic electrocardiogram examination and 988 children with ASD who underwent transcatheter closure were assigned as two control groups.The difference of AIVR incidence rate was compared between VSD transcatheter closure group and control groups. Seventeen cases developed AIVR after transcatheter closure of VSD，but no one had subjective symptoms.Nine cases  were treated with methylprednisolone，albumin and creatine phosphate sodium and the other 8 cases had no therapy.All the 17 children with AIVR received follow-up study. Results　The incidence rate of AIVR in transcatheter VSD closure group was higher than in control groups.Based on the first-month holter monitoring electrocardiogram，all the 17 AIVR cases after transcatheter VSD closure recovered to normal，whether they receive treatment or not.And in the follow-up study，there were no adverse medical events. Conclusion　AIVR incidence with transcatheter closure of VSD is higher than other patients.The mechanism of AIVR is closely related to the procedure of transcathter VSD closure.AIVR after transcatheter VSD closure is a benign arrhythmia that perhaps needs not treat ment.