СТРУКТУРНО-ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ СЕРДЦА У ПАЦИЕНТОВ МОЛОДОГО ВОЗРАСТА С ЖЕЛУДОЧКОВОЙ ЭЛЕКТРОКАРДИОСТИМУЛЯЦИЕЙ В ОТДАЛЕННОМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ

Abstract

Aim. To study the structural and functional state of the heart in young patients with ventricular pacing in the long-term postoperative period. Materials and methods. The study included 60 people aged 18 to 35 years (35 men and 25 women) with AV blocks that required the implantation of a permanent pacemaker (PM). The first group consisted of 30 people with permanent PMs implanted after surgical correction of CHD due to postoperative AV blockage. The second group consisted of 30 people with non-surgical AV block. All patients underwent a general clinical examination, echocardiography, and medical documentation was retrospectively studied. The duration of pacing in group 1 was 15.6 (13.1; 18.0) years, in group 2 - 15.7 (13.9; 18.5) years. All patients of both groups at the time of the study were implanted with two-chamber PMs. The median percentage of ventricular stimulation in both groups was 100%.Results. In the study groups, significant differences were revealed in the anteroposterior size of the left atrium (LA): 36.5 (33.5; 39.5) mm and 33.5 (31.0; 36.0) mm (U = 281.0, p = 0.030), suggesting initial changes in LA geometry in patients of group 1. Signs of LV remodeling (concentric and eccentric hypertrophy and concentric remodeling) were detected in 40% (12 people out of 30) of patients in group 1 and in 10% (3 people out of 30) in group 2 (χ2 = 7.20, p = 0.007). In group 1, LV ejection fraction (EF) in B mode was significantly lower than in group 2 and made up 59.0 (52.0; 63.0) % and 61.5 (56.0; 66.0)% (U = 307.5, p = 0.034), respectively. 40% of patients in group 1 and 17% in group 2 had LVEF < 55% (χ2 = 4.02, p = 0.045). LV diastolic dysfunction was detected in 26% of people in group 1; in group 2, no patients with diastolic dysfunction were identified (F = 0.154, p = 0.005).Conclusion. In patients with long-term ventricular stimulation after surgical correction of congenital heart disease, significant structural and functional changes in the heart were revealed (signs of remodeling of the left heart, systolic and diastolic dysfunction of the left ventricle), which appear to be significant predictors of cardiovascular events, including heart failure and mortality. In patients with non-surgical AV block and long-term ventricular pacing no significant impairment of cardiac function was detected.