Interventricular mechanical dyssynchrony determines abnormal heightening of plasma N-terminal probrain natriuretic peptide level in symptomatic bradyarrhythmia patients with chronic dual-chamber vs. single-chamber atrial pacing.

Abstract

OBJECTIVE:

Debates about adverse effects of ventricular- vs. atrial-based pacing have never ended, especially regarding cardiovascular outcomes in common pacemaker populations.

METHODS:

To investigate the contribution of right ventricular apical pacing to the left ventricular negative remodeling, we measured the inter- and intraventricular mechanical dyssynchrony by echocardiography as well as plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level in 116 consecutive patients of symptomatic bradyarrhythmias including sinus node dysfunction (SND) in 80 and atrioventricular block in 36. Dual-chamber rate-modulated pacing (DDDR) pacemakers were implanted in 76 patients (SND, 40), and single-chamber ventricular rate-modulated pacing (AAIR) pacemakers in 40 (all SND). Clinical manifestations were retrospectively correlated.

RESULTS:

After 3.5 years of pacing, DDDR pacemaker patients demonstrated higher plasma NT-proBNP concentration (503 +/- 111 pg/ml) than AAIR patients (194 +/- 42 pg/ml, p = 0.002) despite similar cardiovascular function at baseline. Multivariate regression analysis revealed that the only predictor of the highest quartile of plasma NT-proBNP, i.e. >or=386 pg/ml, was the interventricular contraction time difference (p = 0.01). Reprogramming to minimize ventricular pacing percentage in 8 patients of SND caused parallel reduction of plasma NT-proBNP.

CONCLUSION:

Interventricular mechanical dyssynchrony, imposed mostly by right ventricular apical pacing, could lead to abnormal heightening of plasma NT-proBNP concentration after chronic DDDR pacing in common pacemaker patients with normal baseline left ventricular function.

• Authors: Jih-Min Lin, Ling-Ping Lai, Chia-Ti Tsai, Lung-Chun Lin, Chuen-Den Tseng, Jiunn-Lee Lin
• Journal: Cardiology (Cardiology) Vol. 110 Issue 3 Pg. 167-73 ( 2008) ISSN: 1421-9751 [Electronic] Switzerland
• PMID: 18057888 (Publication Type: Comparative Study, Journal Article)
• Copyright: (c) 2007 S. Karger AG, Basel.

Chemical References

• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Adult
• Aged
• Aged, 80 and over
• Bradycardia (blood, physiopathology, therapy)
• Cardiac Pacing, Artificial (adverse effects, methods)
• Echocardiography
• Female
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Sick Sinus Syndrome (blood, physiopathology, therapy)
• Ventricular Dysfunction (diagnostic imaging, etiology)