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目的:探讨先天性膜周部室间隔缺损(PMVSD)经导管介入治疗后新发异位心律失常(EA)的类型、转归及危险因素。方法:228例成功接受介入封堵治疗的PMVSD患者,于术前、术后1周、术后1、3、6个月及每年分别行常规心电图、24h动态心电图检查。结果:45例(19.7%)患者在介入封堵PMVSD术后(2.26±1.06)天出现61例次新发EA,包括加速性室性自主心律25例次、加速性交界性自主心律14例次、室性早搏14例次、交界性逸搏心律8例次。所有EA患者均未给予特殊处理,43例(95.6%)病人的EA平均持续(4.16±2.71)天,2例患者在1月随访时恢复正常心律。术后随访(14.85±12.52)个月,未发现新发的EA。PMVSD缺损口下缘距三尖瓣隔瓣距离(DDSTV)及缺损口上缘距主动脉瓣右冠瓣环距离(DDRAV)与术后EA的发生有关,当DDSTV≤2.45mm或DDRAV≥3.05mm时对术后EA的发生具有较好的预测价值。结论:EA是PMVSD介入治疗后常见并发症,但预后较好。对具有危险因素的PMVSD患者,介入治疗后需密切监测心电图变化,及时处理。
Objective: To investigate the types, outcomes and risk factors of new-onset ectopic arrhythmias (EA) after catheterization of congenital membranous ventricular septal defect (PMVSD). Methods: Two hundred and eighty-eight patients with PMVSD who were successfully treated with interventional occlusion were examined by conventional electrocardiogram and 24h electrocardiogram at preoperative and postoperative week 1, 3, 6, and every year respectively. Results: Among the 45 patients (19.7%), 61 newly-emergent EA appeared on day 2.26 ± 1.06 after PMVSD was occluded, including 25 cases of accelerated ventricular autonomic arrhythmias and 14 cases of accelerated junctional autonomic arrhythmias , 14 cases of premature ventricular contractions, junctional escaping rhythm in 8 cases. No specific treatment was given in all patients with EA, and the mean EA of 43 patients (95.6%) persisted (4.16 ± 2.71) days on average. Two patients returned to normal heart rhythm at January follow-up. After follow-up (14.85 ± 12.52) months, no new EA was found. The distance between the lower edge of the PMVSD defect and the tricuspid valve septum (DDSTV) and the upper margin of the lesion from the right aortic arch ring (DDRAV) were related to the occurrence of postoperative EA. When DDSTV≤2.45mm or DDRAV≥3.05mm The occurrence of postoperative EA has better predictive value. Conclusion: EA is a common complication after PMVSD intervention, but the prognosis is good. PMVSD risk factors for patients with interventional ECG monitoring needs to be closely monitored changes in a timely manner.