SURGICAL TACTICS OF TREATMENT OF PATIENTS WITH BRADYARRHYTHMIAS IN THE PRESENCE OF MULTIFOCAL ATHEROSCLEROTIC VASCULAR LESIONS

Aim. Improvement of surgical treatment of patients with chronic bradyarrhythmias in the presence of multifocal atherosclerotic lesions. Materials and Methods. 160 patients (atrioventricular block in 102, sick sinus syndrome – in 58, average age 59.8±3.9 years) were examined. All patients underwent general clinical examination, electrocardiography, echocardiography, ultrasound duplex scanning of brachiocephalic arteries, coronary angiography on indications. The following operations were performed: implantation of a singlechamber pacemaker – in 56, of a dual chamber pacemaker – in 104 patients. Results. In 43.1% of patients with bradyarrhythmias, atherosclerotic lesions of the internal carotid artery were revealed, including more than 70% stenosis – in 24.6% of patients. According to the data of coronary angiography, 92% of patients had significant coronary lesions – a three-vessel lesion of the coronary arteries (28.6%), lesion of the left main coronary artery (11.3%). Conclusions. For patients with bradyarrhythmias and multifocal atherosclerotic lesions of the peripheral arteries and concomitant ischemic heart disease, a step-by-step tactic has been developed that consists in a step-by-step revascularization of the affected arterial pools, which is less traumatic and allows to reduce the risk of cardiac complications.