title: Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: A single-center experience on 1046 cases.
abstract: BACKGROUND
  Complete atrioventricular block (cAVB) has been deemed a rare complication after transcatheter closure for ventricular septal defect (VSD). However, this serious event appears to be underrecognized and is worth being investigated further.
  
  
  OBJECTIVE
  To determine the incidence and predisposing factors of cAVB associated with closure of VSD using a modified double-disk occluder (MDO).
  
  
  METHODS
  From December 21, 2001 to December 31, 2014, 1046 patients with perimembranous ventricular septal defect underwent percutaneous closure using the MDO. Electrocardiography was evaluated before the procedure, within 1 week after the procedure, and then at 1, 3, 6, and 12 months and every year thereafter. Other baseline and procedural parameters were also evaluated and a comparison between patients requiring pacemakers and those not suffering from cAVB was done.
  
  
  RESULTS
  cAVB occurred in 17 patients (1.63%) after the procedure. Of the 17 patients, 8 underwent permanent pacemaker (PPM) implantation. The cAVB occurred within 30 days after the procedure in 14 patients and after 1 year in 3 patients. In comparison patients aged ≤18 years, patients aged >18 years were more prone to cAVB (P = .025). Logistic regression revealed no significant parameter to predict later requirement for PPM.
  
  
  CONCLUSIONS
  The incidence of cAVB after transcatheter closure of VSD was acceptable, as part of the cAVB population recovered after administration of corticosteroid and application of a temporary pacemaker. Late cAVB (>1 year) appears to make it more difficult to restore normal conduction block. Because of the recurrence of cAVB, life-long follow-up with periodic electrocardiography examination may be mandatory.
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Bai
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chang-Yong
authors.initials: CY
authors.lastname: Li
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jia-Qi
authors.initials: JQ
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Shao-Ping
authors.initials: SP
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: You
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: xianxianz2010@163.com.
authors.forename: Xian-Xian
authors.initials: XX
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: ybaismmu@aliyun.com.cn.
authors.forename: Yong-Wen
authors.initials: YW
authors.lastname: Qin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complete atrioventricular block; Complication; Percutaneous; Perimembranous ventricular septal defect