vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-1576vestar-1628Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESВлияние впервые возникшей стойкой блокады левой ножки пучка Гиса на прогноз пациентов после транскатетерной имплантации клапана «МедЛаб-КТ» в средне-отдаленном периоде наблюденияThe impact of persistent left bundle branch block on the midterm prognosis after transcatheter «MedLab-CT» valve implantationhttps://orcid.org/0000-0001-6089-9722БазылевВ. В.BazylevV. V.

Пенза, ул. Стасова, д. 6. 

Penza, 6 Stasova str 

https://orcid.org/0000-0003-4702-8249ПопыльковаО. В.PopylkovaO. V.

Попылькова Оксана Васильевна 

Пенза, ул. Стасова, д. 6. 

Popylkova Oksana 

Penza, 6 Stasova str 

popylkova@yandex.ruhttps://orcid.org/0000-0002-9406-8537УшаковР. Ю.UshakovR. Yu.

Пенза, ул. Стасова, д. 6. 

Penza, 6 Stasova str 

https://orcid.org/0000-0002-7078-1274ВоеводинА. Б.VoevodinA. B.

Пенза, ул. Стасова, д. 6. 

Penza, 6 Stasova str 

https://orcid.org/0000-0002-4973-510XДурмановС. С.DurmanovS. S.

Пенза, ул. Стасова, д. 6. 

Penza, 6 Stasova str 

ФГБУ «Федеральный центр сердечно-сосудистой хирургии» МЗ РФРоссияFSBI «Federal Center for Cardiovascular Surgery» of the MH RFRussian Federation2026130320263315359Copyright © Базылев В.В., Попылькова О.В., Ушаков Р.Ю., Воеводин А.Б., Дурманов С.С., 20262026Базылев В.В., Попылькова О.В., Ушаков Р.Ю., Воеводин А.Б., Дурманов С.С.Bazylev V.V., Popylkova O.V., Ushakov R.Y., Voevodin A.B., Durmanov S.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1628Цель

Цель. Изучить влияние впервые возникшей стойкой полной блокады левой ножки пучка Гиса (ПБЛНПГ) на прогноз пациентов после транскатетерной имплантации аортального клапана (ТИАК) «МедЛаб-КТ» в среднеотдаленном периоде наблюдения.

Материал и методы исследования. В исследование включено 129 пациентов после процедуры ТИАК, выполненной по поводу аортального стеноза, изначально не имевших ПБЛНПГ. Средний возраст пациентов 70,2±5,2 лет, доля мужчин составила 36%, индекс массы тела пациентов 31,4±5,9 кг/м2, гипертоническая болезнь диагностирована у 93%, сахарный диабет - 32%, ИБС - 59% пациентов, пароксизмальная форма фибрилляции предсердий зарегистрирована у 16%, постоянная форма фибрилляции предсердий - 3% пациентов. По данным эхокардиографии (ЭхоКГ) конечный диастолический объем левого желудочка составил 107,7±30,9 мл, фракция выброса 61,4±10,4 %, максимальный и средний градиент давления на аортальном клапане - 91,7±25,7 мм рт.ст. и 52,7±16,4 мм рт.ст., соответственно. Показатель ширины комплекса QRS был равен 84,1±12мс. В зависимости от возникновения ПБЛНПГ после процедуры ТИАК больные были разделены на 2 группы: в первую группу вошло 98 пациентов без ПБЛНПГ (ширина комплекса QRS -98,4±16 мс), во вторую - 31 пациент с ПБЛНПГ (ширина комплекса QRS 149,6±17 мс). По остальным клинико-демографическим и ЭхоКГ показателям группы были сопоставимы. Период наблюдения составил 60 месяцев.

Результаты

Результаты. При сравнении двух групп пациентов не было выявлено различий по данным ЭхоКГ, также были сопоставимы показатели летальности от всех причин. В группе пациентов с впервые развившейся стойкой ПБЛНПГ после ТИАК за время наблюдения двум пациентам был имплантирован электрокардиостимулятор (6,45%; p=0,001). Наличие впервые возникшей стойкой ПБЛНПГ не увеличивало летальность от всех причин у пациентов после ТИАК (ОШ 1,084; ДИ=0,353-3,209; р=0,912).

Заключение

Заключение. Впервые возникшая ПБЛНПГ не увеличивает летальность у пациентов после ТИАК Мед-ЛабКТ «МедИнж» в средне-отдаленном периоде наблюдения, но ассоциируется с более высоким риском развития атриовентрикулярной блокады высокой степени, требующей имплантации электрокардиостимулятора.

Aim

Aim. The aim of the study was to study the effect of first appeared persistent left bundle branch block on the prognosis of patients after «MedLab-CT» transcatheter aortic valve implantation (TAVI) in the middle long-term follow-up period.

Methods

Methods. The study included 129 patients after the TAVI procedure, who initially did not have LBBB. The average age of patients was 70.2±5.2 years, body mass index - 31.4±5.9 kg/m2, the proportion of men was 36%, arterial hypertension was diagnosed in 93%, diabetes mellitus in 32%, coronary heart disease in 59% of patients, paroxysmal form of atrial fibrillation was registered in 16%, permanent form of atrial fibrillation - in 3% of patients. According to echocardiography the end-diastolic volume was 107.7±30.9 ml, the ejection fraction was 61.4±10.4%, the maximum and average pressure gradient on the aortic valve was 91.7±25.7 mmHg and 52.7±16.4 mmHg respectively. The width of the QRS complex was 84.1±12ms. Depending on the occurrence of LBBB after the TAVI procedure, the patients were divided into 2 groups: the first group included 98 patients without LBBB (the width of the QRS complex was 98.4±16ms), the second included 31 patients with LBBB (the width of the QRS complex was 149.6±17ms). The groups were comparable in other clinical, demographic and ultrasound parameters. The follow-up period was 60 months.

Results

Results. There were no differences in echocardiography data in both groups, and mortality rates from all causes were also comparable. During the follow-up period in the LBBB group two patients was implanted a pacemaker (6.45%; p=0.001). The LBBB after TAVI did not increase all-cause mortality in patients (OR 1.084; DI= 0.353-3.209; p=0.912).

Conclusion

Conclusion. The first time arisen LBBB does not increase mortality in patients after TAVI «MedLab-CT» in the middle long-term follow-up period, but it is associated with a higher risk of developing a high-grade atrioventricular block requiring pacemaker implantation.

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