Development and validation of a nomogram for predicting early arrhythmia risk after transcatheter closure of ventricular septal defect in children

ZHANG Hai-yong; ZHANG Hui-feng; MA Jia-jia; WU Peng-peng; LIU Gui-dong; DU Chao-jun

doi:10.3969/j.issn.1672-5301.2026.02.010

Abstract：Objective To develop and validate a nomogram for predicting early arrhythmia risk after transcatheter closure of ventricular septal defect(VSD)in children.Methods The clinical data(modeling set)of 150 children with transthoracic VSD occlusion admitted to Anhui Children's Hospital and Children's Hospital of Fudan University from September 2021 to August 2024 were retrospectively selected.According to whether arrhythmia occurred within 3 months after operation,they were divided into occurrence group and non-occurrence group,an early warning model was established.In addition,64 children who underwent transthoracic VSD closure in our hospital from September 2024 to August 2025 were selected as the validation set to verify the established model.The clinical data of the occurrence group and the non-occurrence group were collected,Univariate and multivariate Lasso-Logistic regression were used to screen the influencing factors of early postoperative arrhythmia.The early warning model was constructed and presented in the form of visual nomogram,and the predictive performance of the model was evaluated and verified.Results The age[(2.86±0.95)years vs.(3.99±1.10)years]in the occurrence group was lower than that in the non-occurrence group,and the operation time[(123.48±19.51)min vs.(96.78±20.33)min]was longer than that in the non-occurrence group,the proportion of 9 F sheath size(5.00%vs.0.00%),asymmetric occluder(62.50%vs.38.18%),the size of the occluder[(8.05±1.00)mm vs.(6.79±1.13)mm],the inner diameter of the pulmonary artery[(23.49±3.61)mm vs.(20.17±4.80)mm],the blood flow velocity of the pulmonary valve[(151.83±9.78)cm/s vs.(144.25±10.67)cm/s]were higher than those in the non-occurrence group(all P<0.05).Age(OR=0.513,95%CI 0.343-0.769),operation time(OR=1.206,95%CI 1.061-1.369),asymmetry of occluder(OR=3.586,95%CI 1.911-6.727)and size of occluder(OR=1.424,95%CI 1.142-1.778)were independent influencing factors of early arrhythmia after transthoracic VSD occlusion(all P<0.05).The consistency index of the prediction model nomogram based on the above factors was 0.939.In the modeling set and validation set:the calibration curve analysis showed that the predicted results of the nomogram were consistent with the actual result curve(the intercept of the calibration curve was 0,and the slope was 1);the receiver operating characteristic curve showed that the area under the curve of the prediction model(nomogram)was 0.960(95%CI 0.902-0.985)and 0.939(95%CI 0.899-0.978),respectively.The sensitivity was 89.21%and 80.00%,respectively,and the specificity was 86.78%and 94.55%,respectively.The clinical decision curve analysis showed that at the threshold probability of 0.05-95%and 0.06-75%,the clinical net benefit could be obtained by using the nomogram to predict early postoperative arrhythmia.The clinical net benefit of the modeling set was up to 27%(threshold probability 0.05),and the clinical benefit of the validation set was up to 30%(threshold probability 0.06).Conclusions Age,operation time,occluder asymmetry and occluder size are independent influencing factors of early arrhythmia after transthoracic VSD closure.The accuracy,predictive performance and predictive value of the risk early warning model are high,which can provide an effective predictive tool for clinical practice.