Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects

Abstract

Objective: To look at the presentation, treatment and outcome of patients who developed atrioventricular block after transcatheter closure of a perimembranous ventricular septal defect (PMVSD) with the Amplatzer PMVSD device. Setting: Three tertiary referral centres for paediatric cardiology in two countries. Results: All three patients presented within 10 days of the procedure. All three patients were treated with intravenous steroids. A permanent pacemaker was inserted in all patients but no pacemaker required activation after two months. Conclusion: Complete atrioventricular block occurring in the weeks after device occlusion of a PMVSD appears to resolve quickly. Continued involvement in multicentre device databases is required to monitor safety.

Atrioventricular Block: A Serious Complication in and After Transcatheter Closure of Perimembranous Ventricular Septal Defects

“…Bundle branch block persisted among patients who developed complete AVBs after the procedure, indicating that the local inflammation mechanism contributed to the arrhythmia. Walsh et al believed that device flattening was another mechanism that may be responsible for some of the delayed occurrences of AVBs, 7 but the shape and the size of the devices did not change significantly in his study. Butera reported delayed onset of complete AVBs after percutaneous closure of the PMVSDs, 14 and transient complete AVBs also occurred after 8 mo in 1 case in our report, but the mechanism of the arrhythmias is still unknown.…”

“…An AVB occurring after the procedure may be due to local inflammation and fibrosis. 7 The left and right ventricular retention disks may result in a localized area of edema and inflammation, which affect the proximal conduction system. Bundle branch block persisted among patients who developed complete AVBs after the procedure, indicating that the local inflammation mechanism contributed to the arrhythmia.…”

“…Using a suitable size occluder may reduce the rate of AVBs. 7 Walsh suggested that it is more suitable to choose a device that is 0.5-1 mm larger than the diameter of the PMVSD, as measured on a TEE. 7 However, the current Amplatzer PMVSD occlusion device available is only in increments of 2 mm.…”

“…1,2,5 However, the complication of atrioventricular block (AVB) emerged due to the close proximity of a PMVSD to the conduction system. 6,7 In this article, we report the incidence of AVBs during and after transcatheter closure of PMVSD with the Amplazter eccentric PMVSD occluder, and the outcome of the complication in our center.…”

Rhythm and conduction abnormalities after transcatheter closure of VSDs: A single-center experience

“…The rate of major complications found in 12 separate studies, including a total of 820 patients in the literature, varies between 0-15%; the highest rate (0-8%) is related to cAVBs requiring pacemaker implantation (1,3,4). cAVBs can occur during the procedure, but there are also cases in which such blocks take as long as 39 months to emerge (2,(4)(5)(6)(7)(8). Predescu et al (7) reported 22% (4/20) of patients had cAVBs late in follow-up.…”