cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2020-35-3-14-31cardiotomsk-1035Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESСовременные подходы к электрокардиостимуляции у детей с атриовентрикулярными блокадами: обзор литературыA review of current approaches to pacing in children with atrioventricular blocksДамбаевБ. Н.DambaevB. N.

Дамбаев Баир Намсараевич, ординатор, отделение детской кардиологии

634012, Томск, ул. Киевская, 111а

Bair N. Dambaev, Resident Physician, Department of Pediatric Cardiology

111a, Kievskaya str., Tomsk, 634012, Russian Federation

bair23105@mail.ruДжаффароваО. Ю.DzhaffarovaO. Yu.

Джаффарова Ольга Юрьевна, кандидат медицинских наук, старший научный сотрудник, отделение детской кардиологии

634012, Томск, ул. Киевская, 111а

Olga Yu. Dzhaffarova, Cand. Sci. (Med.), Senior Research Fellow, Department of Pediatric Cardiology

111a, Kievskaya str., Tomsk, 634012, Russian Federation

oyd@cardio-tomsk.ruСвинцоваЛ. И.SvintsovaL. I.

Свинцова Лилия Ивановна, доктор медицинских наук, ведущий научный сотрудник, отделение детской кардиологии

634012, Томск, ул. Киевская, 111а

Liliya I. Svintsova, Dr. Sci. (Med.), Leading Research Fellow, Department of Pediatric Cardiology

111a, Kievskaya str., Tomsk, 634012, Russian Federation

lis@cardio-tomsk.ruhttps://orcid.org/0000-0003-4823-4378ПлотниковаИ. В.PlotnikovaI. V.

Плотникова Ирина Владимировна, доктор медицинских наук, заведующий отделением детской кардиологии

634012, Томск, ул. Киевская, 111а

Irina V. Plotnikova, Dr. Sci. (Med.), Head of the Department of Pediatric Cardiology 

111a, Kievskaya str., Tomsk, 634012, Russian Federation

ivp@cardio-tomsk.ruhttps://orcid.org/0000-0002-6531-7223СморгонА. В.SmorgonA. V.

Сморгон Андрей Владимирович, младший научный сотрудник, отделение функциональной и лабораторной диагностики

634012, Томск, ул. Киевская, 111а

Andrey V. Smorgon, Junior Research Fellow, Department of Functional and Laboratory Diagnostic 

111a, Kievskaya str., Tomsk, 634012, Russian Federation

 

 

sav.ssmu@gmail.comКриволаповС. Н.KrivolapovS. N.

Криволапов Сергей Николаевич, врач по рентген-эндоваскулярным диагностике и лечению, отделение хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции

634012, Томск, ул. Киевская, 111а

Sergey N. Krivolapov, Interventional Cardiologist, Department of Interventional Arrhythmology

111a, Kievskaya str., Tomsk, 634012, Russian Federation

cardiorhythm@mail.ruГуляевА. М.GulyaevA. M.

Гуляев Авенир Мильевич, кандидат медицинских наук, врач-рентгенолог, отделение рентгеновских и томографических методов диагностики

634012, Томск, ул. Киевская, 111а

Avenir M. Gulyaev, Cand. Sci. (Med.), Radiologist, Department of Radiology and Tomography

111a, Kievskaya str., Tomsk, 634012, Russian Federation

MGwork1@yandex.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation2020161020203531431Copyright © Дамбаев Б.Н., Джаффарова О.Ю., Свинцова Л.И., Плотникова И.В., Сморгон А.В., Криволапов С.Н., Гуляев А.М., 20202020Дамбаев Б.Н., Джаффарова О.Ю., Свинцова Л.И., Плотникова И.В., Сморгон А.В., Криволапов С.Н., Гуляев А.М.Dambaev B.N., Dzhaffarova O.Y., Svintsova L.I., Plotnikova I.V., Smorgon A.V., Krivolapov S.N., Gulyaev A.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1035

В настоящее время электрокардиостимуляция является основным методом лечения у детей с жизнеугрожающими брадиаритмиями. Атриовентрикулярная блокада (АВБ) высокой степени остается основным показанием для постоянной электрокардиостимуляции в детском возрасте. Факторами, определяющими специфику имплантации устройств в педиатрической популяции, являются антропометрические данные ребенка и соответствие их размерам стимулятора и электродов, необходимость длительной (пожизненной) кардиостимуляции и многократной замены электрокардиостимулятора (ЭКС),  высокий  уровень  активности  ребенка,  изменение  физических  размеров  тела в динамике (необходимость имплантации электродов «с запасом» и их замены), в ряде случаев – сопутствующие врожденные пороки сердца (ВПС), особенно при наличии внутрисердечных шунтов. Одним из спорных вопросов детской кардиостимуляции остается выбор способа имплантации (эпикардиальный или эндокардиальный). Согласно публикациям последних лет, использование методик эпикардиальной имплантации электродов находит все большее применение как в силу более серьезных осложнений трансвенозной электрокардиостимуляции, так и в связи с возможностью выбора гемодинамически оптимальной зоны стимуляции при эпикардиальной методике для предотвращения пейсмейкер-индуцированной диссинхронии. Такой подход позволяет максимально оттянуть установку эндокардиальной системы стимуляции, применение которой актуализирует нерешенную на сегодняшний день не только в России, но и в мире проблему эндоваскулярной экстракции электродов у детей. В статье представлен обзор литературы по применению постоянной ЭКС у детей, рассмотрены преимущества и недостатки применения эндокардиальной и эпикардиальной систем ЭКС, обсуждаются различные способы имплантации и режимы ЭКС, наиболее часто применяемые в педиатрической практике.

Pacing is currently the main method of treatment in children with life-threatening bradyarrhythmias. The high-grade atrioventricular block remains the main indication for permanent pacing in children. The factors that determine the specificity of device implantation in the pediatric population are as follows: anthropometric data of a child and their compliance with the size of a pacemaker and the electrodes, the need for long-term (lifelong) cardiac stimulation and multiple replacements of a pacemaker, high level of child’s activity, changes in the physical parameters of the body over time (the need for implantation of the leads “with reserve” and their replacement), and, in some cases, the presence of concomitant congenital heart defects, especially, with intracardiac shunts. One of the controversial issues in pediatric cardiac stimulation is choosing a method of implantation (epicardial or endocardial). According to recent reports, the epicardial lead implantation techniques are increasingly being used because the transvenous pacemakers are associated with more serious complications and due to the capability to choose hemodynamically optimal stimulation zone in epicardial technique to prevent pacemaker-induced dyssynchrony. This approach allows to ultimately postpone the implantation of the endocardial stimulation system, administration of which is associated with the problem of endovascular lead extraction in children, the problem, which has not been resolved not only in Russia but also worldwide. This review article discusses recent literature on the use of permanent pacing in children, including the advantages and disadvantages of using the endocardial and epicardial pacemaker systems as well as various methods of implantation and pacemaker modes most often used in pediatric practice.

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