E.S. VASICHKINA¹, T.K. KRUCHINA^1,2, T.M. PERVUNINA¹, D.F. EGOROV^1,3, D.S. LEBEDEV¹

¹ V.A. Almazov Federal North-West Medical Research Centre of the Ministry of Health of the Russian Federation, 2 Akkuratov Str., St.-Petersburg, Russian Federation, 197341

² St.-Petersburg State Pediatrics Medical University, 1 Litovskaya Str., St.-Petersburg, Russian Federation, 197341

³ First St.-Petersburg State Medical University named after Academician I.P. Pavlov, 6/8 Tolstoy Str., St.-Petersburg, Russian Federation, 197022  

Vasichkina E.S. — D. Med. Sc., Head of Scientific-Research Laboratory of Children’s Arhythmology of Scientific-Research Department of Arhythmology, tel. +7-921-935-18-90, e-mail: Vasichkinalena@mail.ru

Kruchina T.K. — D. Med. Sc., Leading Researcher of Scientific-Research Laboratory of Children’s Arhythmology, Professor of the Department of Pediatrics named after Prof. I.M. Vorontsov, tel. +7-812-702-68-22, e-mail: tkruchina@gmail.com

Pervunina T.M. — Cand. Med. Sc., Director of the Institute for Perinatology and Pediatrics, tel. (812) 702-68-22, email: ptm.pervunina@yandex.ru

Egorov D.F. — D. Med. Sc., Professor, Chief Expert of Scientific-Research Laboratory of Children’s Arhythmology, tel. +7-8128702-68-22, e-mail: egorovdf@mail.ru.

Lebedev D.S. — D. Med. Sc., Professor, Head of Scientific-Research Department of Arhythmology, tel. +7-812-702-68-22, e-mail: lebedevdmitry@mail.ru.

 This study objective is to assess the results of the clinical course and dynamics of electrophysiological parameters of binodal disease (BD) in children with implanted pacemakers.

We enrolled 40 consecutive patients with BD who underwent pacemaker implantation. 24 (60 %) of them were males, 16 (40 %) — females. The average age for the moment of pacemaker implantation was 13.84±0.621 (2.8-17.9) years. The longevity of persistence of BD before the pacemaker implantation had been 5.31±4.36 years (several days — 14.29). BD included: combined sinus node dysfunction and atrioventricular (AV) conduction disturbance. All children underwent complex heart examination at least 2 times: ECG, 24-hour Holter monitoring (HM). transesophageal electrophysiologic study (TEEPS) before pacemaker implantation and ECG, HM, noninvasive electrophysiologic study after pacemaker implantation. Long-term follow up of patients was 52.2+35.22 months (range 2.7 to 145.9). There was a statistically significant increase in the duration of SNRT from 1617.7 ± 441.6 ms at the first examination to 1915.37 ± 655.7 ms at the end of follow-up (p = 0.04). In addition, there was a significant decrease in the Wenckebach point from 117 ± 35.52 pulses / min. to 102.2 ± 30.42 pulses / min. (p <0.05).

Among children with binodal disease who underwent pacemaker implantation, the monitoring showed improvement of clinical and hemodynamic aspects of the disease, but as a whole this group experienced worsening of electrophysiological parameters.

Key words: binodal disease, permanent pacing, children, electrophysiological study.

REFERENCES

1. Kaplan B.M., Langendorf R., Lev M., Pick A. Tachycardia-bradycardia syndrome (so-called «sick sinus syndrome»). Pathology, mechanisms and treatment. Am. J. Cardiol, 1973, vol. 31, no. 4, pp. 497–508.
2. Shkol’nikova M.A., Polyakova E.B. Sindrom slabosti sinusovogo uzla [Sinus node weakness syndrome]. Diagnostika i lechenie narusheniy ritma i provodimosti serdtsa u detey. Saint Petersburg: Chelovek, 2012. Part 5. Pp. 206–224.
3. Adrianov A.V., Antsupova E.S., Vasichkina E.S. et al. Metodika provedeniya chrespishchevodnykh elektrofiziologicheskikh issledovaniy serdtsa u detey: metodicheskie rekomendatsii [Methods of conducting transesophageal electrophysiological studies of the heart in children: methodical recommendations]. Saint Petersburg: TsMT SPbGPMA, 2004. 48 p.
4. Vasichkina E.S., Kruchina T.K., Lebedev D.S., Egorov D.F. Vegetative binodal dysfunction in children. Features of a natural current. Kazanskiy meditsinskiy zhurnal, 2015, vol. 96, no. 4, pp. 609–615 (in Russ.).
5. Vasichkina E.S., Kruchina T.K., Pervunina T.M. et al. Combined lesion of the sinus node and atrioventricular junction in children. Clinical and electrophysiological characteristics and course of the binodal pathology. Vestnik SPb.skogo universiteta. Seriya 11. Meditsina, 2012, no. 2, pp. 58–67 (in Russ.).
6. Park H.W., Cho J.G., Yum J.H. et al. Clinical characteristics of hypervagotonic sinus node dysfunction. Korean J. Intern. Med, 2004, vol. 19, no. 3, pp. 155–159.
7. Sakai Y., Imai S., Sato Y. et al. Clinical and electrophysiological characteristics of binodal disease. Circ. J, 2006, vol. 70, no. 12, pp. 1580–1584.
8. Schneier R., Brandes A., et al. Development of sinus node disease in patients with AV block: implications for single lead VDD pacing Wiegand UK, bode F, 2008, vol. 10, no. 2, pp. 134–1347.
9. Borovikov V. STATISTICA. Iskusstvo analiza dannykh na komp’yutere [STATISTICA. The art of data analysis on a computer]. Saint Petersburg: Piter, 2001. 650 p.
10. Rebrova O.V. Statisticheskiy analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm STATISTICA [Statistical analysis of medical data. Application of the STATISTICA]. Moscow: Media-Sfera, 2002. 312 p.
11. Yunkerov V.I., Grigor’ev S.G. Matematiko-statisticheskaya obrabotka dannykh meditsinskikh issledovaniy: lektsii dlya ad»yunktov i aspirantov [Mathematico-statistical processing of medical research data: lectures for adjuncts and post-graduate students]. Saint Petersburg: VMA, 2005. 266 p.
12. Rubenstein J.J., Schulman C.L., Yurchak P.M., De Sanctis R.W. Clinical spectrum of the sick sinus syndrome. Circulation, 1972, vol. 46, no. 1, pp. 5–13.
13. Vallin H., Edhag O. Associated conduction disturbances in patients with symptomatic sinus node disease. Acta Med. Scand, 1981, vol. 210, no. 4, pp. 263–270.