[The Phenomenon of Short PQ Interval in Children].

Data of analysis of the clinical course of a natural phenomenon of short PQ interval in 300 children are presented. During the period.

[Asymptomatic ventricular pre-excitation in children: a 17 year follow-up study].

Results of long term clinic-electrophysiological follow-up of a large group of children with Wolf-Parkinson-White (WPW) phenomenon are present. From 1993 to 2011 we examined 176 children - 117 boys (66,5%) and 59 girls (33,5%) - with manifesting type of WPW. Age at first examination was 12.5+/-3.2 ( 0.1 18 ). In 66.5% of children WPW phenomenon was present in the age from 10 to 18 . Hundred fifty nine children (104 [65.4%] boys and 55 [34.6%] girls) were followed up for 0.5-17 years (mean 7.4+/-4.5 years). During follow-up spontaneous attacs of atrioventricular reciprocal tachycardia appeared in 13 children (8.2%, 95% confidence interval [CI] 4.4-13.6%). Spontaneous disappearance of signs of ventricular pre-excitation on electrocardiogram and transition to intermittent form of WPW were registered in 14(8.8%, 95%CI 4.9-14.3%) and 12 children (7.5%, 95% CI 3.9-12.8%). Short lasting syncopal states were observed in 15 children (8.4%). In 3 of them atrial fibrillation with high rate of venricular rhytm was induced during transesophageal electrophysiological study. Two (1.3%) children had history of clinical death. In one of them WPW phenomenon was combined with hypertrophic cardiomyopathy and polymorphic ventricular tachycardia. This child died at the age of 11 years. One (0.6%) boy with WPW phenomenon died suddenly in 3 years after initial examination. Thus, children with WPW phenomenon are at risk of development of life threatening states and sudden cardiac death. Stratification of risk of sudden death is necessary at examination of such children.

[Recommendations for implanting cardiac pacemakers in bradycardia]. / Rekomendatsii dlia implantatsii élektrokardiostimuliatorov pri bradikardiiakh.

The paper gives recommendations for cardiologists and cardiac surgeons who are engaged in working out indications, choice of the type and mode of cardiac pacing. Based on the understanding of the great importance of nomenclature documents concerning the development of indications for pacemakers implantation, the Working Group of the Expert Committee, Ministry of Health of the Russian Federation and Russian Academy of Medical Sciences, for implantable antiarrhythmic devices and electrophysiology has developed recommendations on pacemaker implantation in acquired atrioventricular (AV) block, in AV-block after myocardial infarction, chronic bi- and tri-fascicular block, sinoatrial nodal dysfunction, hypersensitive carotid sinus syndrome, neurovascular syndromes, as well as in childhood bradyarrhythmias. In developing the recommendations, the authors have used their own 25-year experience in implanting pacemakers and the recommendations proposed by the Working Group of the American College of Cardiologists and the American Association of Cardiologists in 1984 and 1991 for implanting pacemakers in bradyarrhythmias. The proposed recommendations define indications and contraindications for implantation of up-to-date pacemaker models and determine the behaviour policy of a specialist in selecting patients with bradyarrhythmias for the optimal pacing mode, which suggests a compulsory certification of the centers engaged in implanting pacemakers in bradyarrhythmias.

[The prognosis and prevention of syncopal states and sudden death in patients with a complete atrioventricular block in disorders of permanent cardiac electrostimulation]. / Prognozirovanie i profilaktika sinkopal'nykh sostoianii i vnezapnoi smerti u bol'nykh s polnoi atrioventrikuliarnoi blokadoi pri narusheniiakh postoiannoi élektrikardiostimuliatsii.

A total of 105 patients with implantable pacemakers were examined. Whether the pacemaker disconnection test can be used to predict syncopes in failure of permanent cardiac pacing was studied. The spontaneous ventricular activity was evaluated in 62 patients with acquired complete atrioventricular block (CAVB) and in 43 patients with artificial CAVB. The patients with varying pacemaker dependence were grouped. It was ascertained that 7% of patients with artificial CAVB and 19% of those with acquired CAVB were dependent on pacemakers. In possible failure of stimulation or in reimplantation of a pacemaker on its disconnection, 93% of patients with artificial CAVB and 81% with acquired CAVB could develop their own cardiac rhythm. Lowering the frequency of pacing enabled the duration of asystole to be decreased. The usage of isadrin was demonstrated to enhance spontaneous ventricular activity.

[The natural course of a complete atrioventricular block]. / Estestvennoe techenie polnoi atrioventrikuliarnoi blokady.

The natural disease course is analyzed in 311 patients with atrioventricular blockade admitted for surgical treatment to the Leningrad Center of Arrhythmia Surgery and Cardiac Pacing. It has been discovered that, as a rule, Morgagni-Adams-Stokes (MAS) attacks do not occur for over 2-3 years after their onset, which determines to a considerable measure the patients: life expectancy. The authors hold that the very first Mas attack which may occur in a patient with atrioventricular blockade is an absolute indication for implantation of a permanent cardiac pacemaker. If the permanent cardiac pacemaker was established, 1-, 3-, 5-, 7- and 8-year survival rates were, respectively, 91.1, 85.8, 77.3, 63.2, and 60.8%.

[The use of multiprogrammable cardiac electrostimulators for treating brady- and tachyarrhythmias in patients with ischemic heart disease]. / Primenenie mul'tiprogrammiruemykh élektrokardiostimuliatorov dlia lecheniia braditakhiaritmii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Examined were 54 patients with different disorders of the cardiac rhythm with an implanted programmed electrocardiostimulator (ECS-200). The authors worked out methods and criteria of choosing individual regimes of electrostimulation, evaluated their effect on the severity of stenocardia and grade of circulatory insufficiency. The threshold frequency of stenocardia is of major significance in determining the optimal frequency of electrostimulation for patients with stable atrioventricular block. For patients with sinus node weakness and transitory atrioventricular blocks the criteria of choice of electrostimulation parameters is maximum maintenance of the sinus node rhythm with a frequency of not less 50/min.

[Equipment and possibilities of dynamic monitoring of arrhythmia during permanent electrocardiostimulation]. / Apparatura i vozmozhnosti dinamicheskogo monitoringa aritmii pri postoiannoi élektrokardiostimuliatsii.

The APKA cardiocomplex was developed, which diagnoses short intermittent arrhythmias in patients with and without cardiocomplexes. The cardiocomplex may operate in inpatient conditions of the cardiosurgical and cardiological units which are engaged in cardiac rhythms and in outpatient conditions of the outpatient monitoring and functional diagnosis rooms.

[Physiologic electrostimulation of the heart ventricles in disorders of atrioventricular conduction]. / Fiziologicheskaia elektrostimuliatsiia zheludochkov pri narusheniiakh atrioventrikuliarnogo provedeniia.

Thirty-two patients with disturbed atrioventricular conduction underwent operation for continuous P-wave electrostimulation (ES) with implantation of Soviet-made serial KC-320 apparatuses by the myocardial (28 patients) and endocardial (4 patients) methods. The patients were examined in postoperative periods of 3 to 15 months. Stable bio-controlled ES with a good clinical result was recorded in 29 patients, dislocation of the atrial endocardial electrode--in one patient; the development of frequent paroxysms of atrial flutter-fibrillation made it necessary to change the ES regimen. The authors' experience allows KC-320 to be recommended in wide clinical practice.

[A case of a iatrogenic defect of the tricuspid valve caused by endocardial electrodes]. / Nabliudenie iatrogennogo poroka trekhstvorchatogo klapana, obuslovlennogo éndokardial'nymi élektrodami.

One case of a rare complication of the permanent heart electrostimulation is observed among many patients treated with such method for many years. A 77-year-old man having a permanent electrostimulation during 13 years because of a complete atrioventricular heart blockade, developed a defect of the tricuspid valve resulting from two endocardial electrodes. Narrowing of the right atrioventricular aperture and a severe dilatation of the right atrium worsened the circulation deficiency. More frequent use of various methods of the nonfunctioning endocardial electrode elimination is recommended. Transvenous destruction of the fibrous capsule at the end of endocardial electrodes is an efficient method developed by the authors for their elimination.

[Experience in the organization of heart surgery services to patients with disorders of heart rhythm and conduction in large cities]. / Opyt organizatsii kardiokhirurgicheskoi pomoshchi bol'nym s narusheniiami ritma i provodimosti serdtsa v usloviiakh krupnogo goroda.

The article generalizes 17-year experience in the organization of surgical service for patients with disturbed rhythm and conductivity of the heart in Leningrad and the northwest region of the USSR. The work of the city center of surgery of arrhythmias is analysed. Prospective calculations were made. Basically new approaches to determining the regular number of persons on the staff and the number and type or operative interventions are suggested.

[Clinical experience with the first 100 operations to implant programmed electrocardiostimulators]. / Klinicheskii opyt pervykh 100 operatsii implantatsii programmiruemykh élektrokardiostimuliatorov.

The implantation of a home programmed device "ECS-500" was performed in 121 patients with different disturbances of the cardiac rhythm. Programmed ECSs were used in 103 patients with echocardiography and integral rheography. Seventy six patients were observed in terms from 2 months to 1.5 year. Optimum frequencies of electrostimulation (ES) were determined for different groups of patients. Lower frequencies of ES allowed to lessen manifestations of angina pectoris in patients with ischemic heart disease. Higher amplitude of the impulse prevented reoperations in 4 patients with "block of output" of electrodes. The experience allows "ECS-500" to be recommended for introduction into clinical practice.

[Organization of the outpatient referral service for patients with disorders of cardiac rhythm and conductivity requiring surgical treatment]. / Organizatsiia vnebo'lnichnoi konsu'ltativnoi pomoshchi bo'lnym s narusheniiami ritma i provodimosti serdtsa, nuzhdaiushchimsia v khirurgicheskom lechenii.

Under analysis were results of the outpatient aid to patients in the center of surgery during 5 years. Every year the consultative and ambulatory aid was given to 1200 patients. A conclusion was made that organization of the city consultative-diagnostic center for patients requiring surgical treatment of arrhythmia with a special staff and equipment for performing electrophysiological and other investigations, organization of the zone consultation units in large polyclinics for electrophysiological investigations will improve the quality and efficiency of treatment of patients with complex disorders of the heart rhythm and conduction.

[Psychological rehabilitation of patients with implanted electrocardiostimulators]. / Psikhologicheskaia reabilitatsiia bol'nykh s implantirovannymi élektrokardiostimuliatorami.

Principles of psychological rehabilitation of patients with implanted cardiac pacemakers are examined. A scheme of stage-by-stage psychoprophylactic and psychotherapeutic measures is proposed. The influence of the psychocorrective action on the process of sociopsychological adaptation of patients is discussed.

[Pilot experience with implantations of 100 continuous atrial pacemakers in sick sinus syndrome: advances, problems, prospects]. / Opyt pervykh 100 operatsii postoiannoi élektrostimulatsii predserdii pri sindrome slabnosti sinusovogo uzla: Dostizheniia, problemy, perspektivy.

Long-term results of continuous atrial pacing were assessed in 100 patients with sick sinus syndrome followed up for 6 years. Implantation of the pacemaker was performed via extrapleural and extraperitoneal approaches using serial myocardial non-suture electrodes. Antiarrhythmic efficacy of atrial pacing was found insufficient. Continuous atrial pacing proved advantageous only in Wenckebach point at 100-120 per min.