TECHNICAL FEATURES OF ELECTRODE IMPLANTATION AND REMOVAL WITH CONSTANT HIS BUNDLE ELECTROCARDIOSTIMULATION

Background. Clinical search for modern, more hemodynamically efficient areas for placing endocardial electrodes with constant cardiostimulation. Our aim is to study electrophysiological parameters and clinical results of His bundle direct stimulation, analyze traits of compromised electrode removal from the given heat area.

Materials and Methods. We examined 36 patients divided into two groups (18 patients in each group) according to the signs of transatrial (first) or transventricle (second) stimulation of His bundle. Up to 12 months from the implantation moment we analyzed electrocardiostimulation parameters, data of body-surface ECG, ultrasound dynamics of heart cavity sizes, life quality according to MOS SF-36 scale.

Results. In the first group time for electrical systole of ventricle myocardium (width QRS) was authentically less – 111 ± 13 ms comparing to the second – 134 ± 19 which corresponded to physiological pattern for myocardial ventricle activation, excluded dyssinchrony, left ventricle diastolic dysfunction, development of arrhythmogenic chronic cardiac insufficiency. Life quality in the first group was authentically higher – 71 ± 8,5 vs 63 ± 9,9 points in patients from the second group. Four electrodes (2 electrodes in each group) were removed due to exit-block development.

Conclusion. Implantation of transatrial electrode in the bundle of His area ensures stable fixation, lower risk of dislocation in the early postoperative period and eases its removal if coinciding indications occur. Clinical application of this medical approach is an impact for creating a peculiar endocardial electrode in native industry, supplying device and stimulator type DDD(R), with a spare ventricle canal which is rather timely regarding conditions for import substitution plan.

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