Brain natriuretic peptide: a marker of cardiac dysfunction with ventricular or dual-chamber pacing

Abstract

Background/Objectives The inability of trials to exhibit the superiority in survival of atrioventricular compared to ventricular pacing can be partially explained by the apical stimulation of the right ventricle, which adversely aff ects both short- and long-term ventricular performance. We evaluated the impact of pacing mode (DDDR vs VVIR) on the brain natriuretic peptide (BNP) level in patients with sick-sinus syndrome (SSS).

Methods Sixty-seven patients were treated with DDDR pacemaker implantation due to SSS. They were randomized during the fi rst post-implant day either to DDDR or VVIR pacing mode and were reevaluated after 30 days. Group A comprised 35 patients on DDDR pacing mode and group B 32 patients on VVIR pacing mode. Peripheral blood samples were drawn for BNP measurement at the time of randomization and one month later.

Results BNP levels increased signifi cantly in both groups at 30 days (group A: 85.6 ± 29.5 pg/ml to 107.2 ± 34.6 pg/ml, group B: 82.7 ± 27.6 pg/ml to 253.1 ± 60.2 pg/ml). On day 30, BNP levels in group B were signifi cantly higher than in group A (P < 0.0001).

Conclusions Pacing from the apex of the right ventricle provokes an increase in the BNP levels regardless of the pacing mode. BNP is probably a very early marker predicting the structural and/or functional heart changes after long-term pacing from the apex of the right ventricle.

Key Words:

• Brain natriuretic peptide
• pacemaker
• cardiac dysfunction.