Neuroendocrine and haemodynamic changes in single-lead atrial pacing and dual-chamber pacing modes

Abstract

Objectives: Neuroendocrine and haemodynamic changes were compared between single-lead atrial (AAI) or dual-chamber (DDD) pacing modes in patients with sick sinus syndrome, in a crossover study. Methods: Inpatients scheduled for their first pacemaker implantation were screened for the following inclusion criteria: sick sinus syndrome; intact atrioventricular conduction; normal QRS interval. All study patients were implanted with a dual-chamber pacemaker, programmed for AAI or DDD pacing mode. Patients were allocated randomly to AAI followed by DDD pacing or to DDD followed by AAI pacing, each mode being applied for 72 h. Echocardiographic, electrocardiographic and neuroendocrine parameters were tested at the end of each pacing mode. Results: From 152 inpatients screened for inclusion, 28 were selected for treatment. Plasma levels of atrial natriuretic peptide (ANP), endothelin, aldosterone and angiotension II were significantly lower, and aortic flow velocity-time integral was significantly higher, in AAI mode than in DDD mode. Aortic pre-ejection interval, interventricular mechanical delay and QRS duration were significantly higher in DDD than in AAI mode. Conclusions: In patients with sick sinus syndrome, DDD pacing mode can induce neuroendocrine system activation, and left ventricular dysfunction and dyssynchrony. These findings discourage the routine use of DDD pacing in patients with sick sinus syndrome.

Characterisation and Comparison of Acute Haemodynamic, Cardiac Biochemical and Hormonal Response to Different Ventricular Pacing Sites in the Normal Heart

“…The current study has modest numbers but is comparable to previous studies [9][10][11]29]. The acute changes in hormonal and biochemical cardiac profile demonstrated in this study have not previously been researched in such a setting and consequently the exact implications of the findings are yet to be determined.…”

Myocardial infarction induces structural and functional remodelling of the intrinsic cardiac nervous system

“…Further, it can accelerate the progression of heart failure and increase mortality (Wilkoff et al 2002;Sweeney et al 2003). A potential mechanism underlying these adverse events relates to activation of the neuroendocrine system (Zhang et al 2013). It is intriguing to hypothesize that modulation of ICNS activity, in conjunction with MI-induced remodelling of afferent neural signals, could be a fundamental link between pacing and neuroendocrine system activation.…”

Review of the epidemiology, pathogenesis and prevention of atrial fibrillation after pacemaker implantation

“…44 On the other hand, the hemodynamic changes caused by permanent pacemaker implantation contribute to increased atrial afterload, which leads to compensatory hypertrophy of cardiomyocytes, and induce the release of a series of neuroendocrine substances (such as tumor necrosis factor alpha (TNF-α) and angiotensin II), and leads to cardiomyocyte apoptosis. 42,45,46 Hypertrophy and apoptosis of cardiomyocytes in the atrial region can cause abnormal changes in local electrical conductivity and eventually lead to AF. Permanent pacemaker implantation can cause changes in myocardial stroma.…”