emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2025.9.1.2411emcardio-116Research ArticleОригинальные научные публикацииOriginal Scientific ResearchКлинико-лабораторные особенности и факторы риска сердечно-сосудистых заболеваний у молодых пациентов с постоянной желудочковой стимуляциейClinical and laboratory features and risk factors for cardiovascular diseases in young patients with permanent ventricular pacingГариповА. С.HarypauA. S.

Минск

Minsk

pat-iv@mail.ruПатеюкИ. В.PatsiayukI. V.

Минск

Minsk

pat-iv@mail.ruКорсаковаЕ. В.KorsakovaE. V.

Минск

Minsk

pat-iv@mail.ruШиловаЛ. В.ShylovaL. V.

Минск

Minsk

pat-iv@mail.ruКотовЮ. А.KotovY. A.

Минск

Minsk

pat-iv@mail.ruКухарчукН. Н.KuharchyukN. N.

Минск

Minsk

pat-iv@mail.ruГолодН. В.HolodN. V.

Минск

Minsk

pat-iv@mail.ruИванюшкоС. К.IvanyushkoK. K.

Минск

Minsk

pat-iv@mail.ruДроздовскийК. В.DrozdovskyK. V.

Минск

Minsk

pat-iv@mail.ruГУ «Республиканский научно-практический центр детской хирургии»Republican Scientific and Practical Center of Pediatric SurgeryИнститут повышения квалификации и переподготовки кадров здравоохранения учреждения образования «Белорусский государственный медицинский университет»Institute of Advanced Training and Retraining of Healthcare Personnel of Belarusian State Medical University2025110920259124112420Copyright © Гарипов А.С., Патеюк И.В., Корсакова Е.В., Шилова Л.В., Котов Ю.А., Кухарчук Н.Н., Голод Н.В., Иванюшко С.К., Дроздовский К.В., 20252025Гарипов А.С., Патеюк И.В., Корсакова Е.В., Шилова Л.В., Котов Ю.А., Кухарчук Н.Н., Голод Н.В., Иванюшко С.К., Дроздовский К.В.Harypau A.S., Patsiayuk I.V., Korsakova E.V., Shylova L.V., Kotov Y.A., Kuharchyuk N.N., Holod N.V., Ivanyushko K.K., Drozdovsky K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/116Цель

Цель. Изучить клинико-лабораторные особенности и факторы риска возникновения сердечно-сосудистых заболеваний (ССЗ) у молодых пациентов с постоянной желудочковой стимуляцией, в т. ч. с послеоперационной атриовентрикулярной блокадой (АВ-блокадой).

Материалы и методы

Материалы и методы. В исследование включено 60 молодых пациентов (35 мужчин и 25 женщин) с электрокардиостимуляторами (ЭКС), имплантированными по поводу АВ-блокады, возникшей в детском возрасте. Причинами имплантации ЭКС у пациентов явились послеоперационная АВ-блокада, развившаяся после хирургической коррекции врожденного порока сердца (ВПС) (30 пациентов, 1-я группа ЭКС+ВПС+) и нехирургическая (постинфекционная, врожденная) АВ-блокада (30 пациентов, 2-я группа ЭКС+ВПС-). Возраст на момент исследования в группах составил 21,7 (19,2; 23,3) года в 1-й группе и 22,7 (20,1; 24,7) года во 2-й группе (р = 0,138) соответственно. Длительность кардиостимуляции в исследуемых группах составила 15,6 (13,1; 18,0) лет и 15,7 (13,9; 18,5) лет (р = 0,889) соответственно. У всех пациентов на момент осмотра был имплантированы двухкамерные электрокардиостимуляторы, процент желудочковой стимуляции составил 100 (99,9; 100)% и 100 (100; 100)% (р = 0,719) соответственно.

Результаты

Результаты. Интегральный уровень N-терминального мозгового натрийуретического пропептида (НТ-МНП) в группах значимо отличался и составил 81,2 (58,9; 189,9) пг/мл в 1-й группе и 30,7 (12,0; 63,7) пг/мл во 2-й группе соответственно (р = 0,000). Артериальная гипертензия была выявлена у 10% пациентов; курение и семейный анамнез – у 16%; избыточная масса тела и ожирение – у 23% пациентов; повышенные уровни глюкозы (≥ 5,6 ммоль/л) – у 28% лиц. Дислипидемия была выявлена у 37% пациентов. Повышенные уровни холестерола липопротеидов низкой плотности (ХС-ЛПНП) и триглицеролов (ТГ) выявлены у 40% исследуемых. У пациентов с полной АВ-блокадой, возникшей после хирургической коррекции ВПС в сравнении с пациентами группы 2 выявлены более низкие значения уровней общего холестерола (ОХ) – 3,7 (3,2; 4,3) ммоль/л и 4,5 (3,8; 5,0) ммоль/л (р = 0,003) соответственно; ХС-ЛПНП – 2,0 (1,7; 2,5) ммоль/л и 2,6 (2,1; 3,2) ммоль/л (р = 0,006) соответственно; холестерола, не связанного с липопротеинами высокой плотности (ХС-ЛП-неВП) – 2,2 (1,8; 2,8) ммоль/л и 2,9 (2,4; 3,4) ммоль/л (р = 0,010) соответственно.

Заключение

Заключение. У пациентов молодого возраста с длительной желудочковой стимуляцией дислипидемия выявлена у 37% лиц, при этом более чем в половине случаев определены два и более ее компонентов. У пациентов молодого возраста с длительной желудочковой стимуляцией после хирургического лечения ВПС в сравнении с лицами с нехирургической АВ-блокадой выявлены значимо более низкие уровни ОХ, ХС-ЛПНП, ХС-ЛП-неВП. Снижение уровня липидов может оказывать негативное влияние на энергетический метаболизм кардиомиоцитов, потенциально способствуя развитию сердечной дисфункции и являться фактором риска сердечной недостаточности у взрослых пациентов с ВПС. У пациентов молодого возраста с длительной желудочковой стимуляцией после хирургического лечения ВПС уровень N-терминального мозгового натрийуретического пропептида (НТ-МНП) составил 81,2 (58,9; 189,9) пг/мл, достоверно превышая значение показателя в группе лиц с нехирургической АВ-блокадой (30,7 (12,0; 63,7) пг/мл, р = 0,000). Доля лиц со значением НТ-МНП ≥ 125 пг/мл (общепринятый диагностический критерий сердечной недостаточности) составила 40% в группе пациентов после хирургического лечения ВПС (в группе с нехирургической АВ-блокадой уровень НТ-МНП не превышал референсных значений, p = 0,0001).

Aim

Aim. To study clinical and laboratory features and risk factors for the development of cardiovascular diseases (CVD) in young patients with permanent ventricular pacing, including those with postoperative atrioventricular block (AV block).

Materials and methods

Materials and methods. The study included 60 young patients (35 men and 25 women) with pacemakers implanted for AV block that developed in childhood. The reasons for pacemaker implantation in patients were postoperative AV block that developed after surgical correction of congenital heart disease (30 patients, group 1 PM+CHD+) and non-surgical (post-infectious, congenital) AV block (30 patients, group 2 PM+CHD-). The age at the time of the study in the groups was 21.7 (19.2; 23.3) years in group 1 and 22.7 (20.1; 24.7) years in group 2 (p = 0.138), respectively. The duration of cardiac pacing in the study groups was 15.6 (13.1; 18.0) years and 15.7 (13.9; 18.5) years (p = 0.889), respectively. All patients had dual-chamber pacemakers implanted at the time of examination; the percentage of ventricular pacing was 100 (99.9; 100)% and 100 (100; 100)% (p = 0.719), respectively.

Results

Results. The integral level of N-terminal brain natriuretic propeptide (NT-proBNP) in the groups was significantly different and amounted to 81.2 (58.9; 189.9) pg/ml in group 1 and 30.7 (12.0; 63.7) pg/ml in group 2, respectively (p = 0.000). Arterial hypertension was detected in 10% of patients; smoking and family history – in 16%; overweight and obesity – in 23% of patients; elevated glucose levels (≥ 5.6 mmol/l) – in 28% of individuals. Dyslipidemia was detected in 37% of patients. Elevated levels of low-density lipoprotein cholesterol (LDL-C) and triglycerols (TG) were detected in 40% of the subjects. In patients with complete AV block that occurred after surgical correction of CHD, lower total cholesterol (OH) levels were found in comparison with patients in group 2 – 3.7 (3.2; 4.3) mmol/l and 4.5 (3.8; 5.0) mmol/l (p = 0.003), respectively; LDL-C – 2.0 (1.7; 2.5) mmol/l and 2.6 (2.1; 3.2) mmol/l (p = 0.006), respectively; cholesterol not bound to high-density lipoproteins (nonHDL-C) –2.2 (1.8; 2.8) mmol/l and 2.9 (2.4; 3.4) mmol/l (p = 0.010), respectively.

Conclusion

Conclusion. In young patients with prolonged ventricular pacing, dyslipidemia was detected in 37% of individuals, with two or more of its components identified in more than half of the cases. In young patients with prolonged ventricular pacing after surgical treatment of CHD, significantly lower levels of TC, LDL-C, and nonHDL-C were found in comparison with those with non-surgical AV block. A decrease in lipid levels can have a negative effect on the energy metabolism of cardiomyocytes, potentially contributing to the development of cardiac dysfunction and being a risk factor for heart failure in adult patients with CHD. In young patients with prolonged ventricular pacing after surgical treatment of CHD, the level of NT-proBNP was 81.2 (58.9; 189.9) pg/ml, significantly exceeding the value of the indicator in the group of people with non-surgical AV block (30.7 (12.0; 63.7) pg/ml, р = 0.000). The proportion of people with an NT-proBNP value ≥ 125 pg/ml (the generally accepted diagnostic criterion for heart failure) was 40% in the group of patients after surgical treatment of CHD (in the group with non-surgical AV block, the level of NT-proBNP did not exceed the reference values, p = 0.0001).

электрокардиостимуляцияврожденный порок сердцаатриовентрикулярная блокадафакторы риска сердечно-сосудистых заболеванийлипидный обменcardiac pacingcongenital heart defectsatrioventricular blockrisk factors for cardiovascular diseaseslipid metabolismReferencesTsao C.W., Aday A.W., Almarzooq Z.I. et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation, 2023, vol. 147, no. 8, pp. e93–e621. doi: 10.1161/CIR.0000000000001123.Tsao C.W., Aday A.W., Almarzooq Z.I. et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation, 2023, vol. 147, no. 8, pp. e93–e621. doi: 10.1161/CIR.0000000000001123.World Health Organization. Fact sheet. Noncommunicable diseases; 2023. Available at: https://www.who.int/ru/news-room/fact-sheets/detail/noncommunicable-diseases. (accessed 09.16.2023). (in Russian).World Health Organization. Fact sheet. Noncommunicable diseases; 2023. Available at: https://www.who.int/ru/news-room/fact-sheets/detail/noncommunicable-diseases. (accessed 09.16.2023). (in Russian).Visseren F.L.J., Mach F., Smulders Y.M. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J., 2021, vol. 42, no. 34, pp. 3227– 3337. doi:10.1093/eurheartj/ehab484.Visseren F.L.J., Mach F., Smulders Y.M. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J., 2021, vol. 42, no. 34, pp. 3227– 3337. doi:10.1093/eurheartj/ehab484.Guo F., Chen X., Howland S. et al. Perceived Stress From Childhood to Adulthood and Cardiometabolic End Points in Young Adulthood: An 18-Year Prospective Study. J Am Heart Assoc, 2024, pp. e030741. doi: 10.1161/JAHA.123.030741.Guo F., Chen X., Howland S. et al. Perceived Stress From Childhood to Adulthood and Cardiometabolic End Points in Young Adulthood: An 18-Year Prospective Study. J Am Heart Assoc, 2024, pp. e030741. doi: 10.1161/JAHA.123.030741.Niwa K. Metabolic Syndrome in Adult Congenital Heart Disease. Korean Circ J, 2019, vol. 49, no. 8, pp. 691–708. doi: 10.4070/kcj.2019.0187.Niwa K. Metabolic Syndrome in Adult Congenital Heart Disease. Korean Circ J, 2019, vol. 49, no. 8, pp. 691–708. doi: 10.4070/kcj.2019.0187.Niwa K. Metabolic syndrome and coronary artery disease in adults with congenital heart disease. Cardiovasc Diagn Ther, 2021, vol. 11, no. 2, pp. 563–576. doi: 10.21037/cdt-20-781.Niwa K. Metabolic syndrome and coronary artery disease in adults with congenital heart disease. Cardiovasc Diagn Ther, 2021, vol. 11, no. 2, pp. 563–576. doi: 10.21037/cdt-20-781.Martínez-Quintana E., Rodríguez-Hernández J.L., Rodríguez-González F. et al. Cardiovascular risk factors and arterial thrombotic events in congenital heart disease patients. Int J Clin Prac., 2019, vol. 73, no № 9, pp. 1–8. doi: 10.1111/ijcp.13378.Martínez-Quintana E., Rodríguez-Hernández J.L., Rodríguez-González F. et al. Cardiovascular risk factors and arterial thrombotic events in congenital heart disease patients. Int J Clin Prac., 2019, vol. 73, no № 9, pp. 1–8. doi: 10.1111/ijcp.13378.Deen J.F., Krieger E.V., Slee A.E. et al. Metabolic Syndrome in Adults With Congenital Heart Disease. J Am Heart Ass, 2016, vol. 5, pp. e0011322016. doi: 10.1161/JAHA.114.001132.Deen J.F., Krieger E.V., Slee A.E. et al. Metabolic Syndrome in Adults With Congenital Heart Disease. J Am Heart Ass, 2016, vol. 5, pp. e0011322016. doi: 10.1161/JAHA.114.001132.Ma F., Li P., Zhang S. et al. Decreased lipid levels in adult with congenital heart disease: a systematic review and Meta-analysis. BMC Cardiovasc Disord, 2023, vol. 23, no. 1, pp. 523. doi:10.1186/s12872-023-03455-w.Ma F., Li P., Zhang S. et al. Decreased lipid levels in adult with congenital heart disease: a systematic review and Meta-analysis. BMC Cardiovasc Disord, 2023, vol. 23, no. 1, pp. 523. doi:10.1186/s12872-023-03455-w.Moon J.R., Song J., Huh J. et al. Analysis of Cardiovascular Risk Factors in Adults with Congenital Heart Disease. Korean Circ J, 2015, vol. 45, no. 5, pp. 416–423. doi:10.4070/kcj.2015.45.5.416.Moon J.R., Song J., Huh J. et al. Analysis of Cardiovascular Risk Factors in Adults with Congenital Heart Disease. Korean Circ J, 2015, vol. 45, no. 5, pp. 416–423. doi:10.4070/kcj.2015.45.5.416.Lui G.K., Rogers I.S., Ding V.Y. et al. Risk Estimates for Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease. Am J Cardiol, 2017, vol. 119, no. 1, pp. 112–118. doi:10.1016/j.amjcard.2016.09.023.Lui G.K., Rogers I.S., Ding V.Y. et al. Risk Estimates for Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease. Am J Cardiol, 2017, vol. 119, no. 1, pp. 112–118. doi:10.1016/j.amjcard.2016.09.023.Jang S.Y., Kim E.K., Chang S.A. et al. Prognosis of Chronic Kidney Disease and Metabolic Syndrome in Adults With Congenital Heart Disease. J Korean Med Sc, 2023, vol. 38, no. 45, pp. e375. doi: 10.3346/jkms.2023.38.e375.Jang S.Y., Kim E.K., Chang S.A. et al. Prognosis of Chronic Kidney Disease and Metabolic Syndrome in Adults With Congenital Heart Disease. J Korean Med Sc, 2023, vol. 38, no. 45, pp. e375. doi: 10.3346/jkms.2023.38.e375.Wang T., Chen L., Yang T. et al. Congenital Heart Disease and Risk of Cardiovascular Disease: A Meta-Analysis of Cohort Studies. J Am Heart Assoc, 2019, vol. 8, no. 10, pp. e012030. doi:10.1161/JAHA.119.012030.Wang T., Chen L., Yang T. et al. Congenital Heart Disease and Risk of Cardiovascular Disease: A Meta-Analysis of Cohort Studies. J Am Heart Assoc, 2019, vol. 8, no. 10, pp. e012030. doi:10.1161/JAHA.119.012030.Bubnova M.G., Persiyanova-Dubrova A.L. Application of the six-minute walk test in cardiac rehabilitation. Kardiovaskulyarnaya terapiya i profilaktika, 2020, vol. 19, no. 4, pp. 2561. doi: 10.15829/1728-8800-2020-2561. (in Russian).Bubnova M.G., Persiyanova-Dubrova A.L. Application of the six-minute walk test in cardiac rehabilitation. Kardiovaskulyarnaya terapiya i profilaktika, 2020, vol. 19, no. 4, pp. 2561. doi: 10.15829/1728-8800-2020-2561. (in Russian).International Diabetes Federation (IDF): consensus criteria for metabolic syndrome. Ozhireniye i metabolism, 2005, vol. 2, no. 3, pp. 47–49. doi: 10.14341/2071-8713-4854.International Diabetes Federation (IDF): consensus criteria for metabolic syndrome. Ozhireniye i metabolism, 2005, vol. 2, no. 3, pp. 47–49. doi: 10.14341/2071-8713-4854.Samokhina Y.U., Redko A.N., Alekseyenko S.N et al. Metabolic syndrome and its associations with socio-demographic and behavioral risk factors in the Russian population aged 25-64 years. Kardiovaskulyarnaya terapiya i profilaktika, 2020, vol. 9, no. 4, pp. 2600. doi:10.15829/1728-8800-2020-2600. (in Russian).Samokhina Y.U., Redko A.N., Alekseyenko S.N et al. Metabolic syndrome and its associations with socio-demographic and behavioral risk factors in the Russian population aged 25-64 years. Kardiovaskulyarnaya terapiya i profilaktika, 2020, vol. 9, no. 4, pp. 2600. doi:10.15829/1728-8800-2020-2600. (in Russian).Stone N.J., Smith S.C.Jr., Orringer C.E. et al. Managing Atherosclerotic Cardiovascular Risk in Young Adults. J. A. C. C. State-of-the-Art Review. J Am Coll Cardiol, 2022, vol. 79, no. 8, pp. 819–836. doi: 10.1016/j.jacc.2021.12.016.Stone N.J., Smith S.C.Jr., Orringer C.E. et al. Managing Atherosclerotic Cardiovascular Risk in Young Adults. J. A. C. C. State-of-the-Art Review. J Am Coll Cardiol, 2022, vol. 79, no. 8, pp. 819–836. doi: 10.1016/j.jacc.2021.12.016.STEPS: Prevalence of risk factors for noncommunicable diseases in the Republic of Belarus, 2020. Copenhagen: WHO Regional Office for Europe; 2022. License: CC BY-NC-SA 3.0 IGO. (in Russian).STEPS: Prevalence of risk factors for noncommunicable diseases in the Republic of Belarus, 2020. Copenhagen: WHO Regional Office for Europe; 2022. License: CC BY-NC-SA 3.0 IGO. (in Russian).Domanski M.J., Tian X., Wu C.O. et al. Time course of LDL cholesterol exposure and cardiovascular disease event risk. J Am Coll Cardio., 2020, vol. 76, no. 13, pp. 1507–1516.Domanski M.J., Tian X., Wu C.O. et al. Time course of LDL cholesterol exposure and cardiovascular disease event risk. J Am Coll Cardio., 2020, vol. 76, no. 13, pp. 1507–1516.Redfield M.M., Rodeheffer R.J., Jacobsen S.J. et al. Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardio, 2002, vol. 40, pp. 976–982. doi: 10.1016/s0735-1097(02)02059-4.Redfield M.M., Rodeheffer R.J., Jacobsen S.J. et al. Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardio, 2002, vol. 40, pp. 976–982. doi: 10.1016/s0735-1097(02)02059-4.Clark M., Kaufman V., Fulks M., Dolan V.F., Stout R.L. NT-proBNP as a predictor of all cause mortality in a population of insurance applicants. J. Insur. Med., 2014, vol. 44, no. 1, pp. 7–16.Clark M., Kaufman V., Fulks M., Dolan V.F., Stout R.L. NT-proBNP as a predictor of all cause mortality in a population of insurance applicants. J. Insur. Med., 2014, vol. 44, no. 1, pp. 7–16.Shalnova S.A., Imayeva A.E., Deyev A.D. et al. Elevated natriuretic peptide levels in the adult population of the regions participating in ESSE-RF and its associations with cardiovascular diseases and risk factors. Kardiologiya, 2017, vol. 57, no. 12, pp. 43–52. doi: 10.18087/cardio.2017.12.10065. (in Russian).Shalnova S.A., Imayeva A.E., Deyev A.D. et al. Elevated natriuretic peptide levels in the adult population of the regions participating in ESSE-RF and its associations with cardiovascular diseases and risk factors. Kardiologiya, 2017, vol. 57, no. 12, pp. 43–52. doi: 10.18087/cardio.2017.12.10065. (in Russian).Shlyakhto Ye.V., Tereshchenko S.N., Chesnikova A.I., Kobalava ZH.D. Chronic heart failure. Clinical guidelines. Klinicheskiye rekomendatsii, 2024, pp. 1–236. Available at: https://cr.minzdrav.gov.ru/recomend/156_2.Shlyakhto Ye.V., Tereshchenko S.N., Chesnikova A.I., Kobalava ZH.D. Chronic heart failure. Clinical guidelines. Klinicheskiye rekomendatsii, 2024, pp. 1–236. Available at: https://cr.minzdrav.gov.ru/recomend/156_2.McDonagh T.A., Metra M., Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J. Heart Fai., 2022, vol. 24, no. 1, pp. 4–131. doi: 10.1002/ejhf.2333.McDonagh T.A., Metra M., Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J. Heart Fai., 2022, vol. 24, no. 1, pp. 4–131. doi: 10.1002/ejhf.2333.Popelová J., Kotaška K., Černý S., Prokopová M., Rubáček M. Range and distribution of NT-proBNP values in stable corrected congenital heart disease of various types. Can J Cardiol., 2012, vol. 28, no. 4, pp. 471–476. doi: 10.1016/j.cjca.2012.01.015.Popelová J., Kotaška K., Černý S., Prokopová M., Rubáček M. Range and distribution of NT-proBNP values in stable corrected congenital heart disease of various types. Can J Cardiol., 2012, vol. 28, no. 4, pp. 471–476. doi: 10.1016/j.cjca.2012.01.015.Eindhoven J.A., van den Bosch A.E., Ruys T.P. et al. N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol, 2013, vol. 62, no. 3, pp. 1203–1212. doi: 10.1016/j.jacc.2013.07.019.Eindhoven J.A., van den Bosch A.E., Ruys T.P. et al. N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol, 2013, vol. 62, no. 3, pp. 1203–1212. doi: 10.1016/j.jacc.2013.07.019.Harypau A.S., Patsiayuk I.V., Terehov V.I. Myocardial perfusion and cardiovascular risk in patients with long-term ventricular pacing in the long period. Emergency cardiology and cardiovascular risks, 2024, vol. 8, no. 1, pp. 2086–2097.Harypau A.S., Patsiayuk I.V., Terehov V.I. Myocardial perfusion and cardiovascular risk in patients with long-term ventricular pacing in the long period. Emergency cardiology and cardiovascular risks, 2024, vol. 8, no. 1, pp. 2086–2097.

The authors declare that there are no conflicts of interest present.