CAJ | 학술논문

目的：探讨经导管封堵室间隔缺损（VSD）术围术期发生心律失常与腔内传导参数改变的关系．方法经导管封堵术的VSD患者50例，使用腔内电图观察封堵术前后腔内心电参数的变化与心律失常的关系．结果（1）与VSD封堵术前比较，术后随访期间共发生心律失常20例，其中束支传导阻滞16例，包括完左2例，完右4例，一过性三度房室传导阻滞（Ⅲ°AVB）1例，在随访中大多可恢复正常；（2）封堵术前、术后心腔内电图示：房室传导参数 A-H、H-V 值（75.10±14.34） ms vs （80.67±23.03） ms 及（47.9±12.61） ms vs （50.07±15.23） ms，差异无统计学意义（＞0.05）．结论（1）经导管VSD封堵术后，部分患者出现新的心电改变，表现为1周内束支传导阻滞增多，但大多可恢复正常，预后良好；（2）术中发生A-H、H-V延长与术后出现各类缓慢心律失常无关；（3）心律失常是VSD封堵术常见的并发症，但严重心律失常发生率低，严格选择适应症，避免采用直径过大的封堵器是减少VSD封堵术后心律失常的有效措施．
목적：탐토경도관봉도실간격결손（VSD）술위술기발생심률실상여강내전도삼수개변적관계．방법경도관봉도술적VSD환자50례，사용강내전도관찰봉도술전후강내심전삼수적변화여심률실상적관계．결과（1）여VSD봉도술전비교，술후수방기간공발생심률실상20례，기중속지전도조체16례，포괄완좌2례，완우4례，일과성삼도방실전도조체（Ⅲ°AVB）1례，재수방중대다가회복정상；（2）봉도술전、술후심강내전도시：방실전도삼수 A-H、H-V 치（75.10±14.34） ms vs （80.67±23.03） ms 급（47.9±12.61） ms vs （50.07±15.23） ms，차이무통계학의의（＞0.05）．결론（1）경도관VSD봉도술후，부분환자출현신적심전개변，표현위1주내속지전도조체증다，단대다가회복정상，예후량호；（2）술중발생A-H、H-V연장여술후출현각류완만심률실상무관；（3）심률실상시VSD봉도술상견적병발증，단엄중심률실상발생솔저，엄격선택괄응증，피면채용직경과대적봉도기시감소VSD봉도술후심률실상적유효조시．
Objective To study the ralationship of arrhythmias and heart electrical parameters changes after transcatheter closure of ventricular septal defect (VSD) .Method 50 patients had been successfully finnished the transcatheter closure of ventricular septal defect,and then we observed ralationship of arrhythmias and heart electrical parameters changes. Results (1) Compared with the situation of VSD occluder preoperative and postoperative, during follow-up there were 20 arrhythmia cases, including bundle branch block 16 cases, including the complete left bundle branch block 2 cases,complete right bundle branch block 4 cases,a transient third-degree trioventricular conduction block 1 case, most return to normal in the follow-up. 2 Intracavitary electrogram showed before and after transcatheter closure:A-V conduction parameters A-H,H-V value of (75.10 ± 14.34) ms vs (80.67±23.03) ms and (47.9±12.61) ms vs (50.07±15.23) ms,the difference was not statistically significant ( >0.05) . Conclusions (1) Some patients with new ECG changes after transcatheter closure of VSD, manifested as an increase in bundle branch block in a week, but most return to normal,the prognosis is good. (2) Intraoperative A-H,H-V extension is not related with with postoperative slow arrhythmia;(3) Arrhythmia is a common complication after VSD transcatheler closure, to strictly selecte indications,and to avoid too large diameter are the effective measures to reduce the arrhythmias after transcatheter closure of ventricular septal defect (VSD) .