The effect of cardiac pacemaker implantation on cardiac performance – the experience of a Cardiology – Rehabilitation Department

Abstract

Background. Although cardiac pacemakers can prevent the occurrence of heart failure secondary to low cardiac output in patients suffering from extreme bradycardia, they can also induce, in some circumstances, heart failure by decreasing the left ventricular stroke volume. In our study, we aim to describe the effect of permanent cardiac pacing on the evolution of patients with heart failure, objectively determined by the N-terminal pro b-type natriuretic peptide (NT-proBNP) dynamics. Material and methods. Complete clinical examination and determination of NT-proBNP were performed before and 5 days after pacemaker implantation. Results. We enrolled in our study 32 patients with an indication for permanent cardiac pacing in which we implanted 21 single-chamber ventricular pacemakers (VVI, 65.6%), 4 single-chamber atrial pacemakers (AAI, 12.5%) and 7 dual-chamber atrio-ventricular pacemakers (DDD, 21.9%). Patients with heart failure had an average NT-proBNP value of 2542.2±2311.12 pg/mL and patients without heart failure (control group), had an average NT-proBNP value of 190.58±98.16pg/mL. Patients in sinus rhythm that received a VVI pacemaker experienced an increase in NT-proBNP values of 103.73%, while patients in atrial fibrillation and VVI of only 0.27%. NT-proBNP values decreased in patients in sinus rhythm that received a DDD or AAI pacemaker by 20.94%. Conclusion. Permanent cardiac pacemakers are able to influence the clinical status of patients with heart failure, especially if they cause the loss of atrio-ventricular synchronism.