Atrioventricular block after transcatheter closure of secundum atrial septal defects using Amplatzer septal occluder in children

LI Jun-jie; LI Yu-fen; ZHANG Zhi-wei; QIAN Ming-yang

Abstract：Objective To determine the incidence, risk factors, prevention and treatment of AVB associated with ASD transcatheter closure using ASO in children. Methods A total of 450 patients underwent transcatheter ASD closure using ASO from March 1998 to December 2005 in our institution. The median age was 6.3 years (ranging from 2.3 to 14 years) and the median weight was 17.4 kg (ranging from 9 to 44 kg). Electrocardiographic tracings before procedure and at follow-up visits were reviewed. The risk factors, prevention and treatments of the AVB were analyzed. Results Fourteen patients developed various AVB (3.1%), including first degree AVB in 6, second degree AVB in 4 and third degree AVB in 4 patients. All AVBs occurred one to two days after transcatheter occlusure of the ASD. Among 14 patients, new-onset AVBs were found in 12 patients and aggravation of preexisting AVBs was noted in 2 patients. The larger device (24 ± 2 vs 19 ± 3mm, P < 0.001) and smaller age(4.3 ± 1.4 vs 7.6 ± 2.3 years,P = 0.03)were two risk factors for AVB. Corticosteroid was routinely used for all patients with AVB and removal of the device was implemented for 4 patients with third degree AVB. A vast majority of cases resolved or improved spontaneously, with no recurrence at short-term follow-up. Conclusions AVB remains the severe complication after interventional catheterization for ASDs using ASO. The larger device and smaller age can be associated with the development of AVB. Selection of the proper ASO may be the most effective measure to prevent AVB after transcatheter closure of ASDs for small children. Most of all AVBs can resume within a short time by giving medical or surgery intervention as soon as possible.