The effect of atrial pacing on left ventricular diastolic function and BNP levels in patients with DDD pacemaker

Abstract

DDD tipi kalıcı kalp pilli olgularda atriyumun elektriksel uyarılmasının sol ventrikül diyastolik fonksiyonu ve BNP seviyeleri üzerine etkisiThe effect of atrial pacing on left ventricular diastolic function and BNP levels in patients with DDD pacemaker 323ABSTRACT Objective: We aimed to investigate the effect of atrial pacing on left ventricular diastolic function and brain natriuretic peptide (BNP) levels in patients with DDD pacemaker. Methods: Thirty patients with complete atrio-ventricular (AV) block and DDD pacemaker were included. All patients had normal left ventricular systolic function. Echocardiographic diastolic function parameters (transmitral and tissue Doppler velocities during early (E and E') and late (A and A') filling) and NT-pro-BNP levels were evaluated prospectively during atrial sensing and pacing periods. Echocardiographic data were compared with paired sample t test and NT-pro-BNP levels were compared with Wilcoxon test. Results: Echocardiographic E/A, E'/A', E/E' ratios were calculated as 0.72±0.34, 0.61±0.21 and 8.76±2.58 during atrial sensing period. Same parameters were found as 0.71±0.23, 0.64±0.16 and 8.93±3.16 respectively during atrial pacing period. Echocardiographic left ventricular diastolic function parameters were not significantly different during atrial pacing and atrial sensing periods. Median plasma NT-pro-BNP levels were measured as 142 pg/ml (min-max 47-563 pg/ml) and 147 pg/ml (min-max 33-1035 pg/ml) during atrial sensing and pacing periods respectively. These levels were not significantly different (p=0.86). .16 olarak saptandı. Atriyal sensing ve pacing dönemlerinde ekokardiyografik E/A, E'/A' ve E/E' ölçümleri arasında istatistik olarak anlamlı bir farklılık saptanmadı. Atriyal sensing döneminde 142 pg/ml (min-maks 47-563 pg/ ml) olan mediyan NT-pro-BNP değeri atriyal pacing döneminde 147 pg/ml (min-maks 33-1035 pg/ml) saptandı. NT-pro-BNP seviyeleri bakımından atriyal sensing ve atriyal pacing dönemlerinde yapılan ölçümler arasında istatistiksel olarak anlamlı bir farklılık bulunmadı (p=0.86). Sonuç: Bu çalışma AV tam bloklu ve normal sol ventrikül sistolik fonksiyonlu olgularda sağ ventrikül pacing'i sırasında gözlenen diyastolik disfonksiyon paterni üzerinde atriyal pacing'in ilave bir kötüleşme yaratmadığını ekokardiyografik olarak ve NT-pro-BNP ölçümleri ile göstermiştir.