Heart rhythm disorders (HRDs) are one of the most complex and urgent problems in both adult and pediatric cardiology. One of the important points of research in the field of arrhythmology is the study of the mechanisms of HRD formation. The mechanisms that trigger arrhythmias in children have their own peculiarity associated with the age-related aspects of the formation of both the cardiovascular system and the systems responsible for its regulation, primarily the autonomic nervous system (ANS). The article presents current literature data on the contribution of the ANS to the formation of arrhythmias and the information content of its markers depending on age.

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.

Background. Currently pacing is the only treatment option for life-threatening bradyarrhythmias. Considering the specific factors of pediatric patients, specialists in this field should be highly professional.Aim: To present the experience and retrospective analysis of complications of permanent pacing in children and adolescents from Tomsk National Research Medical Center.Material and Methods. Complications of permanent pacing in children with structurally normal heart and children with congenital heart defects were analyzed. The follow-up was from 1999 to 2021 years. 256 patients aged from 1 month to 18 years participated in the study. Epicardial pacemaker was implanted in 173 children, endocardial – in 83 patients. Average time from primary implantation to complications was 2.1 ± 2.7 years.Results. Hemodynamic complications are the most common among patients with epicardial and endocardial permanent pacing. Hemodynamic complications with epicardial permanent pacing are associated with intraventricular dissynchrony due to stimulation in the area of the lateral wall or the right ventricular outflow tract. In patients with endocardial permanent pacing hemodynamic complications are associated with the development of pacemaker-induced cardiomyopathy due to permanent pacing of the right ventricle apex and tricuspid regurgitation. Complications such as bacterial endocarditis, infection of the pacemaker and its bed, hemopericardium, subclavian vein occlusion, pericarditis, peacemaker dislocation and lead fracture were less common. Two cases of cardiac strangulation were detected.Conclusion. Neither epicardial nor endocardial pacemaker implantation guarantee the absence of complications. Implantation of the electrode on the apex of the left ventricle (epicardial pacemaker system), in the area of the His bundle (endocardial pacemaker system), prevents the development of hemodynamic complications. The most rational is the use of a primary epicardial pacemaker system. Such approach allows the veins to be preserved for endocardial stimulation at an older age.