Previous Next


№4' 2019


International Medical Journal, Vol. 25., Iss. 4, 2019, P. 13−17.



Dmitrii Aleksandrovich Lopyn, Stanislav Valerevich Rybchynskyi, Dmitrii Evgenevich Volkov

State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine

Currently the electrophysiological treatment options have been considered to be the most effective for many patients with arrhythmogenic cardiomyopathies, as well as in those with arrhythmias on the background of heart failure. Currently, the dependence of efficiency of the pacemakers on the location of the electrodes has been proven. In order to study the effect of a myocardial dysynchrony on the effectiveness of pacing depending on the location of the right ventricular electrode, an investigation has been performed. This study comprised the patients with a complete atrioventricular block, preserved ejection fraction of the left ventricle (more than 50 %), with no history of myocardial infarction, who were implanted with the two−chamber pacemaker. It has been established that the best results were achieved with a stimulation of the middle and lower septal zone of the right ventricle, the worst ones were obtained with a stimulation of its apex. It has been found that the dynamics of the magnitude of segmental strains and a global longitudinal strain coincided with the dynamics of other parameters of the pacemaker effectiveness, which indicated the pathogenetic value of myocardial dysynchrony in the progression of heart failure after implantation of the pacemaker. Therefore it could be concluded that the studying of myocardial mobility by determining a longitudinal strain for assessing the functional state of the myocardium and the effectiveness of pacing is highly advisable. It is emphasized that the use of the latest strains−dependent techniques for cardiac performance evaluation in the patients with bradyarrhythmia have a great potential to predict the development of chronic heart failure and to choose the optimal method of physiological stimulation of the heart.

Key words: right ventricular lead, cardiac stimulation, myocardial dyssynchrony.


1. Retrospektivnyj analiz rezultatov primeneniya hronicheskoj resinhroniziruyushej terapii u pacientov s serdechnoj nedostatochnostyu / L. A. Bokeriya, O. L. Bokeriya, T. S. Bazarsadaeva [i dr.] // Annaly aritmologii.− 2012.− № 1.− S. 32−36.

2. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device−based therapy of cardiac rhythm abnormalities. A report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society; C. M. Tracy, A. E. Epstein, D. Darbar [et al.] // Circulation.− 2012.− № 126.− R. 1784−1800.

3. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy / M. Brignole, A. Auricchio, G. Baron−Esquivias [et al.] // Eur. Heart J. − 2013.− № 34.− R. 2281−2329.− doi: 10.1093/eurheartj/eht150

4. Vsesvitnij den sercya yak gaslo ta zmist zasidannya Prezidiyi NAMN Ukrayini // Gazeta "".− 10.10.2016.− № 39 (1060).− URL: http://www.apteka. ua/article/magazine/1060/page3

5. Tantengco M. V. Left ventricular dysfunction after longterm right ventricular apical pacing in the young / M. V. Tantengco, R. L. Thomas, P. P. Karpawich // J. Am. Coll. Cardiol.− 2001.− Vol. 15 (8).− P. 2093−2100.−1097(01)01302−x

6. Dual chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial / B. L. Wilkoff, J. R. Cook, A. E. Epstein [et al.] // J. Am. Med. Assoc.− 2002.− Vol. 288 (24).− P. 3115−3123.

7. Right ventricular septal pacing: a comparative study of outflow tract and mid ventricular sites / R. Rosso, C. Medi, A. W. The [et al.] // Pacing and Clin. Electrophysiol.− 2010.− Vol. 33 (10).− P. 1169−1173.−8159.2010.02836.x

8. Relation of right ventricular pacing site to left ventricular mechanical synchrony / A. J. Verma, M. S. Lemler, I. J. Zeltser, W. A. Scott // Am. J. Cardiol.− 2010.− Vol. 106 (6).− P. 806−809.

9. Vdovenko D. V. Ocenka funkcionalnogo sostoyaniya levyh otdelov serdca u bolnyh hronicheskoj serdechnoj nedostatochnostyu s sohranennoj frakciej vybrosa / D. V. Vdovenko, R. A. Libis // Ros. kardiologicheskij zhurn.− 2019.− № 24 (2).− S. 26−30.− URL:− 4071−2019−2−26−30

10. Nakaz MOZ Ukrayini "Standarti nadannya dopomogi kardiologichnim hvorim" vid 03.07.2006 № 436.

11. Celujko V. I. Ocenka deformacii miokarda levogo zheludochka v klinicheskoj praktike / V. I. Celujko, K. Yu. Kinoshenko, N. E. Mishuk // Liki Ukrayini.− 2014.− № 9 (185).− S. 52−56.

12. De Cock S. C. Comparison of the haemodynamic effects of right ventricular outflow−tract pacing with right ventricular apex pacing: a quantitative review / S. C. De Cock, M. C. Giudici, J. W. Twisk // Europace.− 2003.− № 3 (3).− R. 275−278.

13. Right ventricular pacemaker lead position is associated with differences in long−term outcomes and complications / C. M. Witt, C. J. Lenz, H. H. Shih [et al.] // J. Cardiovasc. Electrophysiol.− 2017.− Vol. 28 (8).− P. 924−930.

14. Right ventricular septal pacing as alternative for failed left ventricular lead implantation in cardiac resynchronization therapy candidates / M. H. Alhous, G. R. Small, A. Hannah [et al.] // Europace.− 2015.− Vol. 17 (1).− P. 94−100.

15. Functional characteristics of left ventricular synchronization via right ventricular outflow−tract pacing detected by two−dimensional strain echocardiography / Y. Hirayama, Y. Kawamura, N. Sato [et al.] // J. of Arrhythmia.− 2017.− Vol. 33 (1).− P. 28−34.

16. His Bundle Pacing: A New Strategy for Physiological Ventricular Activation / A. Lewis, P. Foley, Z. Whinnett et al.] // J. of the Am. Heart Association.− 2019.− Vol. 8 (6).− e010972.

Go on Top