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. ≥386 pg/ml, was the interventricular contraction time difference (p = 0.01). Reprograming 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.
| Original language | English |
|---|---|
| Pages (from-to) | 167-173 |
| Number of pages | 7 |
| Journal | Cardiology |
| Volume | 110 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Jun 1 2008 |
| Externally published | Yes |
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Keywords
- Brain natriuretic peptide
- Mechanical dyssynchrony
- Permanent pacemaker
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
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. / Lin, Jih Min; Lai, Ling Ping; Tsai, Chia Ti; Lin, Lung Chun; Tseng, Chuen Den; Lin, Jiunn Lee.
In: Cardiology, Vol. 110, No. 3, 01.06.2008, p. 167-173.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - 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
AU - Lin, Jih Min
AU - Lai, Ling Ping
AU - Tsai, Chia Ti
AU - Lin, Lung Chun
AU - Tseng, Chuen Den
AU - Lin, Jiunn Lee
PY - 2008/6/1
Y1 - 2008/6/1
N2 - 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. ≥386 pg/ml, was the interventricular contraction time difference (p = 0.01). Reprograming 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.
AB - 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. ≥386 pg/ml, was the interventricular contraction time difference (p = 0.01). Reprograming 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.
KW - Brain natriuretic peptide
KW - Mechanical dyssynchrony
KW - Permanent pacemaker
KW - Brain natriuretic peptide
KW - Mechanical dyssynchrony
KW - Permanent pacemaker
UR - http://www.scopus.com/inward/record.url?scp=44849112941&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=44849112941&partnerID=8YFLogxK
U2 - 10.1159/000111926
DO - 10.1159/000111926
M3 - Article
C2 - 18057888
AN - SCOPUS:44849112941
VL - 110
SP - 167
EP - 173
JO - Cardiology
JF - Cardiology
SN - 0008-6312
IS - 3
ER -