Complete heart block after occlusion and repair for perimembranous ventricular septal defect.

Abstract

Background: Complete atrioventricular conduction block (CAVB) is a major complication of the repair and occlusion of perimembranous ventricular septal defects (pmVSDs).

Objective: This study aimed to analyse the incidence and risk factors of CAVB after occlusion and repair of pmVSD.

Methods: We reviewed patients with pmVSDs who underwent occlusion and repair between January 2010 and January 2022. Permanent CAVB was defined as a CAVB requiring permanent pacemaker implantation or occluder extraction.

Results: Of 2436 patients who underwent pmVSD repair, 7 (0.3%) developed permanent CAVB. In all, 16 (0.7%) of the 2200 patients in the device group developed permanent CAVBs. All permanent CAVBs in the repair group occurred during hospital stay. In contrast, eight (50%) permanent CAVBs in the device group occurred over 1 month. A large pmVSD size (odds ratio [OR], 1.575; 95% confidence interval [CI], 1.260-1.970, p < 0.001) and device/defect ratio (OR, 2.608; 95% CI, 1.587-4.287, p < 0.001) were independent risk factors for permanent CAVB after surgical repair and device occlusion, respectively. Multivariate regression showed that device occlusion versus surgical repair was associated with a significantly higher risk of permanent CAVBs (OR, 4.675; 95% CI, 1.586-13.780, p = 0.005).

Conclusion: The incidence rates of permanent CAVB after device occlusion and surgical repair were 0.7% and 0.3%, respectively. Large VSD size and device/defect ratio were independently associated with permanent CAVB after surgical repair and device occlusion, respectively. Compared with surgical repair, device occlusion was associated with a significantly higher risk of permanent CAVB after pmVSD closure.