vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-1334KYHZRYvestar-1402Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESПервый опыт Гисиальной кардиостимуляции у педиатрических пациентовFirst experience of His bundle pacing in pediatric patientshttps://orcid.org/0000-0002-3947-4903ДжаффароваО. Ю.DzhaffarovaO. Yu.

Томск, пер. Кооперативный, д. 5

Tomsk, 5 Kooperativny lane

https://orcid.org/0000-0002-2056-4060СвинцоваЛ. И.SvintsovaL. I.

Свинцова Лилия Ивановна

Томск, пер. Кооперативный, д. 5

Svintsova Liliya

Tomsk, 5 Kooperativny lane

lis@cardio-tomsk.ruhttps://orcid.org/0000-0001-8121-8287КриволаповС. Н.KrivolapovS. N.

Томск, пер. Кооперативный, д. 5

Tomsk, 5 Kooperativny lane

https://orcid.org/0000-0002-5352-1323ПеревозниковаЮ. Е.PerevoznikovaYu. E.

Томск, пер. Кооперативный, д. 5

Tomsk, 5 Kooperativny lane

https://orcid.org/0000-0002-6531-7223СморгонА. В.SmorgonA. V.

Томск, пер. Кооперативный, д. 5

Tomsk, 5 Kooperativny lane

https://orcid.org/0000-0003-2469-8098КартофелеваЕ. О.KartofelevaE. O.

Томск, пер. Кооперативный, д. 5

Tomsk, 5 Kooperativny lane

НИИ кардиологии, Томский национальный исследовательский медицинский центр РАНРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation2024230920243132532Copyright © Джаффарова О.Ю., Свинцова Л.И., Криволапов С.Н., Перевозникова Ю.Е., Сморгон А.В., Картофелева Е.О., 20242024Джаффарова О.Ю., Свинцова Л.И., Криволапов С.Н., Перевозникова Ю.Е., Сморгон А.В., Картофелева Е.О.Dzhaffarova O.Y., Svintsova L.I., Krivolapov S.N., Perevoznikova Y.E., Smorgon A.V., Kartofeleva E.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1402Цель

Цель. Оценить эффективность и безопасность гисиальной стимуляции у педиатрических пациентов.

Материал и методы исследования. Шести пациентам была выполнена эндокардиальная имплантация кардиостимулятора с имплантацией желудочкового электрода в гисиальную позицию. Проводилось стандартное диагностическое обследование, включающее рутинные общеклинические и лабораторные обследования, ЭКГ с оценкой ширины QRS, холтеровское мониторирование ЭКГ (ХМ ЭКГ), эхокардиографию (ЭхоКГ) с оценкой размеров, объемов камер сердца и сократительной функции левого желудочка (ЛЖ) и Speckle-tracking ЭхоКГ с оценкой глобальной продольной деформации ЛЖ (GLS ЛЖ). В ходе динамического контроля проведены ЭКГ, ХМ ЭКГ, ЭхоКГ и Speckle-tracking ЭхоКГ.

Результаты

Результаты. Селективная стимуляция пучка Гиса (изолированный захват системы Гиса-Пуркинье) была достигнута только у одного пациента, у остальных 5 пациентов выполнена неселективная гисиальная стимуляция. На фоне гисиальной селективной и неселективной стимуляции отмечена значимая нормализация показателя электромеханической диссинхронии ЛЖ (GLS) с -17 [-15;-19] до 21,4 [-21;-22] (p=0,013). Наиболее значимая нормализация продольной деформации ЛЖ регистрировалась у пациента с предшествующей ранее эпикардиальной стимуляцией правого желудочка.

Выводы

Выводы. Физиологическая гисиальная стимуляция способствует синхронизации желудочков, обеспечивая наиболее физиологическую стимуляцию миокарда, как при первичной импланатции электрокардиостимулятора, так и у пациента с предшествующей длительной стимуляцией правого желудочка, сопровождающиеся желудочковой диссинхронией.

Aim

Aim. To present our clinic’s experience of His bundle pacing in pediatric patients.

Methods

Methods. Six patients underwent endocardial pacemaker implantation with a ventricular lead in the Hisian position. A standard diagnostic examination was carried out, including routine general clinical and laboratory examinations, an ECG with an assessment of QRS width, Holter monitoring, echocardiography (Echo) with an assessment of the sizes, volumes of the heart chambers, left ventricle (LV) contractile function and Speckle-tracking Echo with an assessment of LV global longitudinal strain (LV GLS). To assess dynamic control ECG, Holter monitoring, Echo and Speckle-tracking Echo were performed.

Results

Results. Selective His bundle pacing (isolated capture of the His-Purkinje system) was achieved in only one patient; non-selective His bundle pacing was performed in the remaining 5 patients. With His bundle selective and non-selective pacing, a significant normalization of the LV electromechanical dyssynchrony index (GLS) was noted from -17 [-15; -19] to -21.4 [-21;-22] (p = 0.013). The most significant normalization of LV longitudinal strain was recorded in a patient with previous epicardial stimulation of the right ventricle (RV).

Conclusion

Conclusion. Physiological His bundle pacing favours ventricular synchronization, providing the most physiological myocardium pacing, both during primary pacemaker implantation and in patients with previous long-term RV pacing, accompanied by ventricular dyssynchrony.

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The authors declare that there are no conflicts of interest present.