儿童室间隔缺损封堵术后早期完全性左束支传导阻滞心电图相关指标的变化

Changes in electrocardiographic parameters in children with complete left bundle branch block early after transcatheter closure of ventricular septal defect

摘要:

目的 观察单纯室间隔缺损（VSD）患儿介入封堵术后早期发生完全性左束支传导阻滞（CLBBB）患儿的心电图变化。方法 纳入21例行膜周部VSD介入封堵且术后早期出现CLBBB的患儿，同时以性别、年龄及封堵器大小进行1 ： 1配对，纳入同时期术后未合并任何心律失常的单纯膜周部VSD的患儿21例作为对照组。比较两组患儿组间及组内术前、术后1 d、术后3 d、术后5 d、术后30 d心电图左室电压、QT间期、心率校正的QT间期（QTc）、QT离散度（QTd）、心率校正的QT离散度（QTcd）、JT离散度（JTd）和心率校正的JT离散度（JTcd）的变化。结果 两组患儿左室电压、JTcd随手术时间的变化而变化（P < 0.05）；左室电压及QTd变化存在时间因素与分组因素的交互效应（P < 0.05）；CLBBB组与对照组的JTcd比较差异有统计学意义（P < 0.05）；CLBBB组与对照组的左室电压在术后3 d和术后5 d组间比较差异有统计学意义（P < 0.05）。结论 VSD患儿介入封堵术后有无CLBBB者早期心电图指标左室电压和JTcd有差异，其中JTcd可能对预测术后早期CLBBB的发生有参考作用。

Abstract:

Objective To observe the changes in electrocardiographic parameters in children with complete left bundle branch block (CLBBB) after the transcatheter closure of simple ventricular septal defect (VSD). Methods A total of 21 children with CLBBB early after transcatheter closure of perimembranous VSD were recruited. Another 21 children without any type of arrhythmia after transcatheter closure of perimembranous VSD were enrolled as the control group. The sex, age, and the size of occluder were matched between the two groups. The changes in the following indices were compared between the two groups:left ventricular voltage, QT interval, corrected QT interval (QTc), QT dispersion (QTd), corrected QT dispersion (QTcd), JT dispersion (JTd), and corrected JT dispersion (JTcd) on the electrocardiogram before transcatheter closure and at 1, 3, 5, 30 days after transcatheter closure. Results Left ventricular voltage and JTcd changed with operation time in the CLBBB and control groups (P < 0.05). There were interaction effects between time and grouping in the changes in left ventricular voltage and QTd (P < 0.05). There was a significant difference in JTcd between the CLBBB and control groups (P < 0.05). There was also a significant difference in left ventricular voltage between the CLBBB and control groups at 3 and 5 days after the transcatheter closure (P < 0.05). Conclusions There are significant differences in electrocardiographic left ventricular voltage and JTcd between VSD children with and without CLBBB early after transcatheter closure. JTcd might be useful in predicting the development of CLBBB early after transcatheter closure of VSD.