Risk Factors and Outcomes of Postprocedure Complete Left Bundle Branch Block After Transcatheter Device Closure of Perimembranous Ventricular Septal Defect

HomeCirculation: Cardiovascular InterventionsVol. 14, No. 2Risk Factors and Outcomes of Postprocedure Complete Left Bundle Branch Block After Transcatheter Device Closure Perimembranous Ventricular Septal Defect Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBRisk Diandong Jiang, MD, Youfei Fan, PhD, Bo Han, Lijian Zhao, Yingchun Yi, Jianjun Zhang, Jianli Lv, MD Jing Wang, JiangDiandong Jiang Department Pediatric Cardiology, Shandong Provincial Hospital Affiliated First Medical University, Jinan, China. Search for more papers by this author , FanYoufei Fan HanBo Han Correspondence to: 324 Jingwu Rd, Jinan 250012, Email E-mail Address: [email protected] https://orcid.org/0000-0001-5286-372X ZhaoLijian Zhao YiYingchun Yi ZhangJianjun Zhang LvJianli Lv WangJing Wang https://orcid.org/0000-0002-0639-6419 Originally published16 Feb 2021https://doi.org/10.1161/CIRCINTERVENTIONS.120.009823Circulation: Interventions. 2021;14:e009823Transcatheter closure perimembranous ventricular septal defects (pmVSDs) have been shown be an alternative conventional surgical repair with acceptable mortality morbidity.1–3 Conduction system abnormalities are not rare well described.2–4 As limited information is available regarding the occurrence complete left bundle branch block (cLBBB) after defect closure, present study was designed assess incidence, risk factors, outcomes cLBBB transcatheter pmVSD in children.From June 2002 2019, 1014 children, who successfully underwent a our center, were reviewed retrospectively study, median follow-up 48 months (range: 6 17 years). The inclusion criteria following: age ≥2 years or weight ≥10 kg, hemodynamically significant (cardiomegaly on chest X-ray; atrial enlargement; [LV] volume overload). devices together procedure described previously.1,2,5 This complied Declaration Helsinki approved Ethics Committee Institution. All patients’ guardians provided written informed consent. data that support findings from corresponding reasonable request.Postprocedure arrhythmia occurred 272 cases (26.8%), 21 (2.07%) atrioventricular 4 (0.4%). No patient progressed during follow-up. LBBB occurring within 7 days classified as early-onset (19 cases) late-onset (2 cases, both procedure).When diagnosed, intravenous dexamethasone (0.5–1.0 mg/kg daily, maximum 10 mg) administered 3 5 tapered gradually over following 2 weeks. Among patients, 16 had recovered normal conduction weeks corticosteroid therapy, restoration occluder removal (together repair) at 13 procedure, 1 case persistent cLBBB. Two recurred cohort post-procedure, one recovering 40 procedure. Both Consequently, total patients cLBBB.These followed up 45 6–144) months, return lost years. One presented symptoms reduced exercise capacity, transthoracic echocardiography increased LV end-diastolic diameter 51 mm (z-score 4.2) progressive reduction ejection fraction 40%, 58 diagnosis Because poor response drug therapy (digoxin, furosemide, spironolactone, captopril, carvedilol) New York Heart Association functional class III, QRS duration 162 ms, cardiac resynchronization 8 returned therapy. remaining asymptomatic, echocardiograph only showing minor signs interventricular dyssynchrony diameters fractions.As Table, using eccentric (OR, 3.29, P=0.018 [95% CI, 1.23–8.78]) highest incidence cLBBB, oversized thin-waist observed associated longer durations appeared likely recur less restore (P=0.001 P<0.001, respectively).The device relatively low, most blocks recover High-dose corticosteroids seemed effective reversing early (n=16/19). We did note rarely can occur later date. Despite prompt recurrent rare. In removal, restored. possible reason might fundamentally relieve compression bundle. experience, steroids should given If weeks, may considered. et al3 large symmetrical occluders prone comparisons performed different types found cLBBB.Some variables reach statistical significance because numbers small (eg, cLBBB), hence, adequately powered their contribution cLBBB.In conclusion, outcome postprocedural favorable. Eccentric avoided.Table. Risk Occurrence, Persistence, Recurrence BlockcLBBB group (n=21)Non-cLBBB (n=993)P valueUnivariateOR (95% CI)P valueAge, y4.05±1.484.62±2.740.3390.91 (0.74–1.11)0.341Weight, kg16.00±4.3618.92±8.800.1300.93 (0.85–1.02)0.126Sex0.811 Male11 (52.4)494 (49.7)11 Female10 (47.6)499 (50.3)0.90 (0.38–2.14)0.811Defect angio, mm4.57±3.334.46±2.990.8731.01 (0.88–1.16)0.872Device diameter, mm7.10±2.346.41±2.110.1401.14 (0.96–1.35)0.142Device type0.047 Symmetrical10 (47.6)662 (66.6)11 Eccentric7 (33.3)141 (14.2)3.29 (1.23–8.78)0.018 Thin-waist3 (14.3)85 (8.6)2.34 (0.63–8.66)0.204 ADO II others1 (4.8)105 (10.6)0.63 (0.08–4.98)0.662Symmetrical occluderEccentric occluderThin-waist occludercLBBB (n=10)Non-cLBBB (n=662)P valuecLBBBgroup (n=7)Non-cLBBB (n=141)P valuecLBBB (n=3)Non-cLBBB (n=85)P years4.20 ± 1.534.56 2.670.6724.14 1.504.96 3.260.5132.70 0.365.14 2.930.156Weight, kg15.40 4.0018.62 8.450.22917.50 5.7520.42 11.100.49213.83 0.2920.37 9.940.260Sex1.0000.9421.000 Male5 (50.0)322 (48.6)4 (57.1)68 (48.2)2 (66.7)54 (63.5) Female5 (50.0)342 (51.4)3 (42.9)73 (51.8)1 (33.3)31 (36.5)Defect mm4.03 2.583.94 1.890.8832.94 0.573.77 1.700.20211.00 2.0011.72 2.250.588Device mm7.00 2.836.42 2.060.3787.00 1.737.30 2.500.7518.67 1.166.07 1.710.011Device / defect1.92 0.381.75 0.380.1642.39 0.432.07 0.520.1160.80 0.080.53 0.140.002Device weight0.46 0.140.40 0.200.3000.41 0.050.42 0.200.8630.63 0.080.34 0.150.001Recovery (n=16)Persistence (n=4)P valueNonrecurrence (n=15)Recurrence (n=3)P years4.31 1.412.83 0.390.0574.46 1.322.67 0.610.038Weight, kg16.13 4.9415.25 1.890.73616.53 4.8213.00 2.650.243Sex0.0940.138 Male6 (37.5)4 (100)5 (33.3)3 (100) (62.5)010 (66.7)0Defect mm3.75 2.488.40 4.300.0093.83 2.546.03 6.030.594Device type0.2800.554 Symmetric8 (50.0)1 (25.0)7 (46.6)1 (33.4) Eccentric6 (37.5)1 (25.0)6 (40.0)1 (33.3) Thin-waist1 (6.25)2 (6.7)1 (6.25)01 (6.7)0Onset time days3.06 1.3491.75 101.910.1803.13 1.3661.33 102.770.430Recovery days5.67 4.0113.67 12.420.381QRS duration, ms141.13 12.61161.0 2.58<0.001139.33 10.73164.0 4.000.001Data n (%) mean#129;}SD. group, new-onset post-procedure; non-cLBBB without recovery restored last follow-up; persistence recurrence initially but developed again; nonrecurrence always maintained recovery. Other included patent ductus arteriosus vascular plug device. P<0.05 considered statistically significant. indicates amplatzer duct II; block; OR, odds ratio.Sources FundingThis supported Key Research Development Plan Province (2016GSF201101); Project Medicine Healthcare Sci-tech (2016WS0441); Special Expert Taishan Scholars (No. ts201511099).Disclosures None.FootnotesFor Sources Funding Disclosures, see page 238.Correspondence hanb[email protected]comReferences1. Yang J, L, Wan Y, Zuo Chen W, Li Sun Yu S, Liu al.. defects: mid-term outcomes.Eur J. 2010; 31:2238–2245. doi: 10.1093/eurheartj/ehq240CrossrefMedlineGoogle Scholar2. Bai Xu XD, CY, Zhu JQ, Wu H, SP, F, You XH, XX, Qin YW. percutaneous defect: single-center experience 1046 cases.Heart Rhythm. 2015; 12:2132–2140. 10.1016/j.hrthm.2015.05.014CrossrefMedlineGoogle Scholar3. C, Zhou K, Luo Shao Shi X, Wei Yan Hua Y. defect.JACC Cardiovasc Interv. 2019; 12:1631–1633. 10.1016/j.jcin.2019.04.043CrossrefMedlineGoogle Scholar4. 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