title: [Prevalence and risk factors of arrhythmias after transcatheter closure of ventricular septal defect in children].
abstract: OBJECTIVE
  To evaluate the prevalence and risk factors of arrhythmia after transcatheter closure of ventricular septal defect (VSD) in children.
  
  
  METHODS
  A total 1 069 children (583 males, mean age (7.7 ± 3.6) years) underwent transcatheter closure of VSD from January 2002 to December 2010 in our hospital were enrolled and retrospectively analyzed.VSD diameters were (4.0 ± 1.8)mm, 336 cases accompanied membranous aneurysm. Electrocardiogram were performed at 1, 3 days after the procedure.Once arrhythmias recorded, electrocardiogram was performed daily till discharge. All cases were followed up by ECG at 1, 3, 6, 12 months after the procedure in outpatient department and then in a year interval. The risk factors were identified by multivariable logistical analysis.
  
  
  RESULTS
  All VSDs were closed successfully and the diameters of occluder was (7.2 ± 2.1)mm. The median follow-up time was 2.2 (1.0-4.2) years. Mortality was zero during follow up.Incidence of early ( < 1 month) post-procedure arrhythmias was 24.6 % (263 cases), and severe arrhythmias were recorded in 50 cases (4.7%). There were 43 late ( ≥ 1 month) post-procedure arrhythmias (4.0%) including 4 (0.4%) complete atrioventricular block. Multivariable logistic analysis revealed that VSD treated with thin-waist-big-side occluder (OR = 2.426, 95%CI:1.835-3.208, P < 0.001) , male gender (OR = 1.267, 95%CI:1.055-1.523, P = 0.011) were the risk factors while higher body weight (OR = 0.838, 95%CI:0.737-0.951, P = 0.006) was protective factor for early onset arrhythmia. Placement of asymmetrical occluder (OR = 4.777, 95%CI:2.079-10.978, P < 0.001) , longer procedure time (OR = 1.011, 95%CI:1.002-1.020, P = 0.012) , occluder from foreign countries (OR = 2.621, 95%CI:1.143-6.014, P = 0.021) were the risks factors for early onset severe conduct block. Treatment with thin-waist-big-side occluder (OR = 2.654, 95%CI: 1.042-6.760, P = 0.041) was the risk factor while higher body weight (OR = 0.373, 95%CI:0.159-0.875, P = 0.023) was a protective factor for late onset conduct block.
  
  
  CONCLUSIONS
  Arrhythmia after transcatheter closure of VSD is common in children, and late onset severe conduct block is rare. The weight of patients should not too light and symmetrical occluder should be chosen if possible in the transcatheter closure VSD procedure to minimize the risk of late onset conduct block.
authors.affiliation: Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Zhong
authors.affiliation: Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China. Email:drzhangzw@sohu.com.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Mingyang
authors.initials: M
authors.lastname: Qian
authors.affiliation: Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Yumei
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Department of Pediatric Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Shushui
authors.initials: S
authors.lastname: Wang
mesh_terms: D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D054537:Atrioventricular Block; D001835:Body Weight; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000453:epidemiology*; D006761:Hospitals; D006801:Humans; D008297:Male; D015995:Prevalence; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors