Effects of right ventricular septal versus apical pacing on plasma natriuretic peptide levels

Abstract

Background:To investigate the contribution of right ventricular (RV) pacing sites to the cardiac function, this study compares plasma B-type natriuretic peptide (BNP) levels during RV septal and apical pacing in patients implanted with a pacemaker.Materials and Methods and Results:Seventy-four consecutive patients with indication for permanent pacing were included. To provide for the possibility of appropriate subgroup analyses, patients were stratified according to their pacing mode into two groups: Those with dual chamber DDD(R)/VDD pacemakers (41 patients, mean age 54.1±18.4 years), and those with single chamber VVI pacemakers (33 patients, mean age 60.6±18.4 years). A prospective single-blinded randomized design was used. Randomization (1:1 way) was between lead placement on the RV septum or RV apex and occurred during the implant in both groups. Compared to baseline, a significant decrease in BNP (429.8±103 pg/ml and 291.7±138 pg/ml, respectively) levels was observed during DDD(R) /VDD pacing after two months. In contrast, during VVI (R) pacing, a significant increase in BNP levels was observed (657.5±104 pg/ml and 889.5±139 pg/ml, respectively). To determine the impact of pacing sites on cardiac function, we assessed the changes in BNP levels in each group separately. Despite the significant difference in the pattern of changes between the two groups (P < 0.02), no significant changes were observed within groups regarding the acute effect of the pacing site (RV apex vs. RV septal) on BNP levels (P=NS).Conclusions:Our main result showed no significant differences between pacing sites and concluded that hemodynamic improvement could be substantially influenced by pacing mode, more than by pacing site.

Effects of Right Ventricular Nonapical Pacing on Cardiac Function: A Meta‐analysis of Randomized Controlled Trials

“…In total, 2,974 articles (with duplicates deleted) were identified by the literature search. Seventeen trials comparing mid‐ and long‐term cardiac functions and nine trials comparing electrical pacing parameters (six trials overlapped) qualified for our meta‐analysis (Fig. ).…”

Impact of DDD and VVIR Stimulation Modes on Functional Capacity and Quality of Life of Chagasic Patients

“…This elevation may be related to AV dyssynchrony or worsening mitral regurgitation secondary to right apical stimulation. In the analysis of this study, the ventricular pacing site was not discriminated, but it is known that its short-term effects are not completely elucidated 22 .…”

Comparison of early effects of right ventricular apical pacing on left ventricular functions in single and dual chamber pacemakers

“…33,29,32,12,14 We considered 6 month follow up to be sufficient to detect relevant changes in natriuretic peptide however levels have been found after even shorter time periods when used in other clinical settings. 17,19,26 We could not fully achieve the blinding of the echocardiographer because the additional lead was visible in the right atrium and the difference between VVI pacing and AV synchrony was also apparent. Finally, the number of patients was relatively small in this study and the data resulting from these analyses should be considered as preliminary observations.…”

“…They concluded that hemodynamic improvement could be substantially influenced by pacing mode, more than by pacing site. 26 Kojuri and colleagues found that level of pro-BNP is lower in double chamber pacing in comparison with single chamber pacing. Therefore, it seems that dual chamber pacing causes less LV dysfunction.…”