Page 45 - Journal of Structural Heart Disease Volume 2, Issue 1

39 Original Research Article
Figure 1. EKGs at baseline and at latest follow up. CAVB = complete atrioventricular block; CLBBB = complete left bundle brach block; CRBBB = complete right bundle branch block; ICRBBB = incomplete right bundle branch block; PM = perimembranous VSD; M = membranous VSD.
patients with VSD device closure. CAVB has been re- ported in up to 5.8% with an asymmetric Amplatzer device [17] and as low as 0.1% with symmetrical oc- cluders [15]. Acute (within 48 hours) and late (at 5 and 12 months post-procedure) CAVB in pmVSD was not- ed by Carminati et al. [18]. Independent risk factors for CAVB include younger age, low body weight, over- sized device, type of device, repeated maneuvers, and position of defects [17–19]. Butera et al. [20] reported two cases of late-onset CAVB at 4 and 12 months af- ter the procedure. Up to 30 days after Amplatzer VSD device closure, recovery of various forms of arrhyth- mias and heart block with corticosteroid therapy was observed [21, 22]. CAVB has been recovered in 70% of the patients within 2 weeks post-procedure after being treated with steroids and isoprenaline [16].
We observed other“benign”conduction and rhythm disturbances in about 12% of the pmVSD group. Of those 12%, there was only one patient who devel- oped LBBB, which is less frequent than that reported in other studies. This LBBB didn’t progress during 5 years of follow up. The pmVSD patients with aneu- rysmal tissue (six patients) that were closed by ductal occluders (ADO) did not show any rhythm disturbanc- es. This may encourage investigators to utilize this approach whenever possible to avoid rhythm com- plications. The other interesting nding in our study was the resolution of IRBBB post-device implantation in two out of four patients who had it at baseline. This observation could be secondary to the decrease in right ventricular volume overload after stopping the left-to-right shunt. Our reported benign conduction
Dilawar, M. et al.
Rhythm disturbances after device closure of VSD