Plasma Brain Natriuretic Peptide as a Biochemical Marker for Atrioventricular Sequence in Patients with Pacemakers

Abstract

We hypothesized that plasma brain natriuretic peptide, like plasma atrial natriuretic peptide, may reflect hemodynamic changes elicited by different cardiac pacing modes. The aim of this study was to investigate whether plasma brain natriuretic peptide could be influenced by different pacing modes or electrical stimulation. The subjects consisted of 164 patients with permanent pacemakers (52 VVI, 30 AAI, 82 DDD pacemakers) and unimpaired heart function. Patients with atrial fibrillation or spontaneous beats were excluded. Plasma atrial natriuretic peptide and brain natriuretic peptide levels were measured at a rate of 70 beats/min after 45 minutes in the supine position. Under ECG monitoring, the pacing mode was switched from DDD to VVI in 12 patients and from DDD to AAI in 4 patients with a dual chamber pacemaker. Plasma atrial natriuretic peptide and brain natriuretic peptide levels were also measured 30 minutes, 60 minutes, and 1 week after mode switching. Plasma atrial natriuretic peptide and brain natriuretic peptide levels were significantly higher in the nonphysiological pacing group than in the physiological pacing group, whereas these values were similar in the DDD and AAI pacing groups. One week after switching from DDD to VVI, plasma atrial natriuretic peptide and brain natriuretic peptide levels were significantly increased, however no significant changes were observed after switching to AAI. Based on a multivariate regression analysis of noninvasive clinical parameters, only a low plasma brain natriuretic peptide was significantly correlated with physiological pacing. We conclude that: (1) plasma brain natriuretic peptide, like atrial natriuretic peptide, is influenced by the pacing mode, but is not influenced by electrical stimulation; and (2) low plasma brain natriuretic peptide is important in relation to physiological pacing.

Cardiomyopathy with Prominent Autophagic Degeneration, Accompanied by an Elevated Plasma Brain Natriuretic Peptide Level Despite the Lack of Overt Heart Failure

“…However, since temporal use of a beta-blocker and/or ACE inhibitor appeared to have affected the plasma BNP level, latent hemodynamic overload in this patient might also have contributed to the increase of the level to some extent. Although artificial pacing can increase the plasma BNP level (13), the level is less than 100 pg/ml, far smaller than that of the present case. We previously reported increased BNP levels in the plasma and cardiac tissue of hearts with hypertrophic cardiomyopathy (8) and amyloid hearts (14) without systolic dysfunction.…”

<b>Blood B-Type Natriuretic Peptide Changes in Different Periods and Different Cardiac Pacing Modes</b>

“…1,3) However, the findings concerning the changes in BNP levels in different periods and different pacing modes have not been completely consistent in published reports. [16][17][18] Compared with VVI(R) pacing mode, DDD(R) can preserve the normal atrioventricular sequence, produce beneficial hemodynamic effects, and reduce ventricular diastolic end pressure. BNP levels during DDD(R) pacing mode, therefore, should theoretically be lower than that during VVI(R) pacing mode.…”

Peptídeo natriurético tipo-B e doenças cardiovasculares

“…Outros autores têm demonstrado que, em pacientes com fibrilação atrial, o peptídeo natriurético tipo-B está aumentado e o miocárdio atrial considerado como fonte da sua produção 25 . Outra evidência da correlação entre arritmias, envolvendo dissincronia atrioventricular e níveis de peptídeo natriurético tipo-B, tem origem em um estudo que demonstrou níveis de peptídeo natriurético tipo-B mais elevados em pacientes com marcapasso em modo VVI do que aqueles em modos DDD ou AAI 26 . Após a cardioversão atrial, o peptí-deo natriurético tipo-B diminui gradualmente 23 .…”