MECHANISMS OF DEVELOPMENT OF TRICUSPID REGURGITATION IN PATIENTS WITH IMPLANTED ELECTRONIC CARDIAC DEVICES AND POSSIBLE WAYS OF ITS CORRECTION

The article is devoted to the study of the mechanisms of tricuspid regurgitation in patients with right ventricular electrodes and possible ways to solve this problem. It is shown that stimulation of the cardiac conduction system (Gis bundle or left branch of the Gis bundle) can prevent tricuspid regurgitation by eliminating asynchronous ventricular contraction and minimizing the mechanical effect on the tricuspid valve. In addition, to preserve the function of the tricuspid valve and prevent the development of tricuspid regurgitation, alternative stimulation methods may be considered, such as the use of leadless pacemakers, surgical placement of epicardial electrodes, pacing of the left ventricle through the coronary sinus, pacing of the atrialized portion of the right ventricle (the part of the right ventricle between the fibrous ring and the displaced leaflets of the tricuspid valve). A radical method of treating electrode-dependent tricuspid regurgitation is electrode extraction, but the decision to remove endocardial electrodes must be strictly reasoned and take into account all the factors that could lead to the development of tricuspid valve insufficiency. Drug therapy for heart failure associated with tricuspid regurgitation is carried out according to general principles and is aimed at improving the symptoms of right ventricular heart failure.