Aim. To present the experience and assess the complications of permanent pacing in children with bradyarrhythmias based on long-term follow-up.Methods. Data of 145 children with structurally normal heart with implanted pacemakers at the age from 1 month to 18 years were retrospectively assessed. The follow-up was from 1999 to 2020 years. Epicardial pacemaker was implanted in 71 children, endocardial - in 74. The mean age of the primary implantation was 8.67±5.2 years.Results. The following complications were disclosed: hemodynamic complications (heart chamber enlargement in dynamics and/or development of dyssynchrony, the appearance and increase in the regurgitation degree on the atrioventricular valves), bacterial endocarditis, hemopericardium, subclavian vein occlusion, pericarditis, infection of the pacemaker and its pocket, leads dislocation and fracture. With epicardial pacing various complications were detected in 24 (33.8%) examined patients, with endocardial - in 37 (50%). Hemodynamic complications with epicardial permanent pacing are associated with intraventricular dyssynchrony due to implantation of a ventricular lead on the lateral wall or the right ventricular outflow tract. Hemodynamic complications were not recorded in patients that performed the implantation of an epicardial lead at the left ventricular (LV) apex.Conclusion. Children with pacemakers require careful follow-up. The most rational is the use of a primary epicardial pacemaker system with lead implantation on the apex of the LV. Such approach allows the veins to be preserved for endocardial stimulation at an older age, and to prevent hemodynamic complications. Neither epicardial nor endocardial pacemaker implantation guarantee the absence of complications. However, compliance with the above conditions will allow achieving high efficiency and safety of cardiac stimulation in children.

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Aim: To evaluate the electrical activity of the myocardium and the radiofrequency (RF) application zone resulting from radiofrequency ablation (RFA) performed at an early age.Material and Methods. A prospective follow-up study included three patients who underwent intracardiac electrophysiological study (EPS) and effective RFA of the tachycardia for the first time at an early age. A reintervention was required in one case 12 years after the procedure and in two cases six years after it due to recurrent and new-onset arrhythmias. During the reintervention, electroanatomical mapping was performed to assess the potential damaging effect of radiofrequency exposure in the area of the first ablation.Results. The intracardiac EPS and amplitude bipolar CARTO-reconstruction of primary ablation area were performed during repeated RFA procedure. The study showed that neither zones with a decrease in the amplitude of electrical signal from the myocardium nor silent electrical zones were present ruling out the cicatricial-sclerotic changes in the myocardium in children in the long-term period after RF exposure.Conclusion. The study showed that no increase in the coagulation necrosis zone in the area of primary ablation occurred during the growth of child when the sparing energy and temperature parameters of RFA and the limited number of RF applications were used. Further research in this area is required.

Первичные кардиомиопатии в детском возрасте представляют собой редкое, но серьезное заболевание, которое является частой причиной сердечной недостаточности и наиболее частой причиной трансплантации сердца у детей старше 1 года. За последние десятилетия диагностика кардиомиопатии продвинулась от традиционных клинических подходов к новым генетическим и визуализационным методам. В статье представлен обзор литературных данных о современной классификации первичных педиатрических кардиомиопатий, особенностях клинического течения и визуализации, которая является неотъемлемой частью диагностики на основе первичного морфофункционального фенотипа.