Clinical analysis of complete left bundle branch block after transcatheter closure of ventricular septal defect in 25 children
Objective To summarize the clinical treatment of complete left bundle branch block(CLBBB)after the transcatheter closure of ventricular septal defect(VSD).Methods A case series study was conducted on the treatments and outcomes of 25 children with CLBBB after transcatheter VSD closure in Guangdong Provincial People's Hospital from January 2010 to December 2023.Paired sample t test was used to evaluate the effect of occlude removal.Results Among the 25 patients,12 were males(48％),and 13 were females(52％).The age at surgery was 3.18(2.51-3.86)years,the height before surgery was 95.0(90.0-97.5)cm,and the weight before surgery was 13(12-15)kg.Fourteen children were early-onset cases(≤ 1 month),while the other 11 were late-onset cases(＞1 month).The mean follow-up time was(6.63±3.93)years.Of the 14 early-onset cases,6 children underwent occluder removal within 1 month and restored normal heart rhythm or incomplete right bundle branch block;4 children underwent occluder removal after 1 month,of whom 2 recovered,1 remained CLBBB,and 1 had complete atrioventricular block(CAVB);the other 4 children received drug treatment,of whom 2 had normal heart rhythm,1 had left anterior fascicular block,and 1 died of cardiac shock and heart failure.All the 11 late-onset cases were first treated by drugs,of whom 3 recovered,and the other 8 remained CLBBB.One of the 8 cases received occluder removal at 8 months after surgery and recovered,1 had CAVB,and the other 6 remained CLBBB.Conclusions For patients with CLBBB after transcatheter closure of VSD,drug therapy is not always effective,and CLBBB is easy to recur.Therefore,occluder removal is recommended to be done immediately after CLBBB is discovered.Patients with persistent CLBBB should be followed up regularly,and pacemaker implantation may be performed if necessary.
Ventricular septal defectComplete left bundle branch blockOccluder removalPacemaker implantation
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