Results of Using Various Conduction System Pacing Options in Patients with Bradyarrhythmia

Chronic right ventricular myocardial pacing causes an asynchronous pattern of left activation, reduces ejection fraction (LVEF), and may be associated with worsening clinical outcomes in the long term. Although emergence algorithms that minimize it became possible to reduce percentage paced complexes patients sinus node dysfunction, permanent is still inevitable high-degree atrioventricular (AV) block. The use conduction system a promising method for preserving physiological activation myocardium preventing development heart failure due dyssynchrony.
 aim. To analyze immediate long-term results indications pacing.
 Materials methods. This study included 18 permanentventricular who were operated at National Amosov Institute Cardiovascular Surgery Academy Medical Sciences Ukraine period from 01/01/2013 12/31/2022, whom was used. There 17 bradyarrhythmias, these 16 (88%) suffered AV block (including 1 patient Frederick’s syndrome (5%) atrial ϐibrillation slow response) ischemic cardiomyopathy bundle branch ϐirstdegree cardiac resynchronization therapy. mean age 55 ± years (8 men, 10 women), LVEF time intervention 56.42 9.13 %, end diastolic volume 130.2 23.8 ml, systolic 55.1 17.7 diameter atrium 4.01 0.6 cm. average QRS width before implantation 116.5 27.7 ms. In 6 (33%) patients, special delivery (С304-L69, Medtronic [5%], C315HIS 5 [27%] patients) 4.1F active ϐixation lead 3830 Select Secure (69 or 74 cm) used; other cases (66%) standard 6F leads lumen stylet without used.
 Results. follow-up after pacemaker 36.35 29.65 months. During observation period, 57.07 5.38 volume111.5 18.09 49.5 13.4 ventricle 3.9 0.5 duration 119.1 10.09 (33%), demonstrate change when amplitude stimulation reduced, 2 variants transitions: 1) 4 (22%) transition non-selective His (NSHBP) selective (SHBP), (11%) SHBP correction (RBBB) RBBB, then loss capture ventricles; 2) NSHBP septal further decrease ventricles. One complete had area pacing. 11 (61%) met criteria parahisian visible transitions global longitudinal strain -17.6 2.7 %. interval stimulus peak R-wave V6, which indicated 73.2 8.7 Pacing parameters standardly set according primary indications, but relative thresholds system. delay corrected latency onset “pseudodelta” wave both H-V interval. no complications acute postoperative period.
 Conclusions. Conduction challenge practice cardiologist treating life-threatening bradyarrhythmias failure, same safe provides electrical mechanical ventricles, allows effectively avoid consequences dyssynchrony