Atrioventricular block after trans catheter VSD closure

Atrioventricular block after device occlusion of a PMVSD is due to the proximity of the conduction bundle to the inferior margin of the defect and may be prone to damage from a PMVSD occlusion device. The estimated incidence of complete atrioventricular block after transcatheter closure is 1–5%. There may be different mechanisms of injury to the atrioventricular conduction bundle. Atrioventricular block occurring immediately after device occlusion may result directly from mechanical compression. Atrioventricular block occurring in the weeks and months after a device occlusion may be due to inflammation and fibrosis. Device flattening is another mechanism that may be responsible for some of the late instances of atrioventricular block. It is recommended abandoning the procedure if complete atrioventricular block occurs on crossing the defect with the delivery sheath. Oversizing apparently should be avoided. There is much uncertainty surrounding the incidence, natural history and treatment of complete atrioventricular block that occurs after device occlusion of a PMVSD. This complication may not be preventable. The effectiveness of pretreatment with local steroids has yet to be determined. The use of initial high-dose intravenous steroids, followed by oral steroids for a period of three weeks is recommended. Whether or not to remove the device is a difficult decision, with patient symptoms, parental preference and institutional preference all entering the equation. If the atrioventricular block resolves with steroids, it is recommended leaving the device in situ. Insertion of a pacemaker will also depend on institutional preference. In our experience in Tabriz University of Medical Sciences none of the 73 patients need permanent or temporary pace maker but two patients had left bundle branch block after the procedure witch resolved by oral prednisolone 60 mg per meter square of body surface area after 3 0r 4 weeks.

کلیدواژه ها:

Atrioventricular block ، catheter ، VSD closure