膜周部室间隔缺损介入治疗后异位心律失常的发生?预后及危险因素
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江苏省"135工程"重点科学基金资助项目(039)


Risk factors and prognosis of ectopic arrhythmia after transcatheter closure of perimembranous ventricular septal defects
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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-24 h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≤2.45 mm或DDRAV≥3.05 mm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-

    Abstract:

    Objective:To investigate the types and prognosis of ectopic arrhythmia(EA) after transcatheter closure of perimembranous ventricular septal defects(PMVSD)and the risk factors of EA. Methods:228 patients with PMVSD were accepted transcatheter closure successfully. Electrocardiogram(ECG) and Holter ambulatory electrocardiographic monitoring were underwent in all patients both pre-and post-procedure,as well as 1,3,6 months and every year after the procedure. Results:Sixty-one case-times of new EA(19.7%) were detected in 45 patients which included 25 case-times of accelerated idioventricular rhythm,14 case-times of accelerated idiojunctional rhythm,14 case-times of ventricular premature beat and 8 case-times of junctional escape rhythm. All the patients with EA had not been given special treatment,EA in 43(95.6%) cases sustained(4.16 ± 2.71) days,2 cases recovered sinus rhythm in the first month of follow-up,and new EA was not found during the follow-up. It was found that the risk factors of EA after closure were related to the distance from the lower margin of the defects to septal leaflet of the tricuspid valve(DDSTV) and the distance from upper margin of the defects to the ring of the right aortic valve(DDRAV). DDSTV ≤ 2.45 mm or DDRAV ≥ 3.05 mm has good predictive value of the incidence of EA. Conclusion:EA is a common complication after transcatheter closure of PMVSD,but with better prognosis in our study. We should closely monitor ECG changes and treat the patients with the risk factors after interventional treatment in time.

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陈 超,杨 荣,盛燕辉,周 蕾,孙 伟,孔祥清,曹克将.膜周部室间隔缺损介入治疗后异位心律失常的发生?预后及危险因素[J].南京医科大学学报(自然科学版),2008,28(8):1011-1014

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  • 收稿日期:2008-03-13
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