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Are Plasma Natriuretic Peptide Levels Influenced by Automatic Pacemaker Algorithms for Ventricular Pacing Minimization?
Author(s) -
KREUZER JOERG,
LENNERZ CARSTEN,
DIETL JOSEF U.,
BEIER THOMAS,
STRAUCH ALEXEJ,
SEMMLER VERENA,
BADRAN HAITHAM,
ZRENNER BERNHARD,
KOLB CHRISTOF
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12070
Subject(s) - medicine , cardiology , natriuretic peptide , ventricular pacing , atrioventricular block , brain natriuretic peptide , algorithm , heart failure , computer science
Background Automatic atrioventricular search hysteresis (AVSH) is designed to reduce the cumulative percentage of potentially deleterious right ventricular apical pacing (VP%) in dual‐chamber pacemakers. We investigated whether minimizing VP% by AVSH can, in turn, reduce ventricular wall stretching/stress, as assessed by plasma concentrations of the amino‐terminal fragment of the pro‐B‐type natriuretic peptide (NT‐proBNP). Methods After dual‐chamber pacemaker implantation in 81 patients (age: 69 ± 11 years; males: 55.6%), the fixed atrioventricular delay of 225 ms was programmed and AVSH was turned off for 1 month. The patients were thereafter randomly assigned to standard AVSH for 1 month, followed by an enhanced AVSH for another month, or vice versa. At the 1‐, 2‐, and 3‐month follow‐ups, VP% values were retrieved from the pacemaker memory, and venous blood samples were taken for NT‐proBNP measurements. Results Both standard and enhanced AVSH reduced the median VP% value from 38.5% (for the fixed atrioventricular delay) to 2.1% (P < 0.001). However, plasma NT‐proBNP concentrations for the fixed atrioventricular delay (median, 253 pg/mL), standard AVSH (225 pg/mL), and enhanced AVSH (276 pg/mL) did not differ significantly on the intrapatient basis (paired Wilcoxon tests) between any pair of these modalities. Conclusion Minimizing ventricular pacing by AVSH during 1 month had no influence on plasma NT‐proBNP levels (i.e., ventricular wall stretching/stress) compared with a constant, moderately prolonged atrioventricular delay.