Estrin S. Permanent pacing in patients with ischimic heart disease. -

The surgical correction of bradiarrhythmias, which were caused by ischimic heart disease (IHD), was performed in 258 patients. Permanent pacing as a main method of the treatment was used in 119 patients on atrioventricular blocks (AVB) and in 139 patients on the sick sinus syndrome (SSS). AAI regimen of ES of the heart was applied in 11,2% of patients in atrioventricular conduction of 110 imp/min and higher, VVI - in 65,1% of patients and DDD - in 23,7% of patients. With the aim to analyze the athero-sclerotic impairments of the coronary arteries 36 coronarographies were carried out in the patients with the artificial rhythm driver. The effect of the pacing regimens on the state of heart failure was estimated. The association of the development of "pacemaker" angina pectoris with the initial rate of the pacing of the heart and with clinical condition of the patient was established. Within the next postoperative period 31 patients died. The main of the death in 80,5% was acute cardiovascular insufficiency, its cause in 35,5% of patients being acute myocardial infarction that developed, after ESC implantation in early post-operative period in 9 patients. In all patients autopsy revealed stenosing atherosclerosis of the coronary arteries mainly of their proximal parts. The risk of death in patients with the isolated ventricular stimula-tion is 7,0 - 3,5% per a year. It is indicated that it is necessary to make a selective coronarography in bradiarrhythmia in patients with IHD after the stabilisation of the cardiac rhythm for the further correction of the coronary circulation. It is proved that the permanent pacing of the heart results in the development of "pacemaker" angina pectoris leads to the destabilization of the coronary circulation. It is established that it is necessary to select the stimulation rate particularly on the first after the ECS implantation to protect of "pacemaker" angina pectoris. The optical regimen of ES of the heart in patients of the young and middle age is bilocular, that allows toreduce lethality in 2,1 times in a distant time. The operation for the ECS implantation in patients with IHD should be considered as on initial stade of the surgical treat-ment with the prospect to reconstruct the coronary channel.