Clinical and laboratory features and risk factors for cardiovascular diseases in young patients with permanent ventricular pacing

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. 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. 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. 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).

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