Conflict of interest: C.K. has received lecture fees from Biotronik, Boston Scientific, Medtronic, Sorin, and St. Jude Medical; is or was an advisor to Biotronik, Sorin, and St. Jude Medical; and has performed clinical trials supported by Biotronik, Medtronic, Sorin, and St. Jude Medical. As of Jan 1, 2012, J.K. is employed by Boehringer Ingelheim Pharma GmbH & Co. KG. Other authors reported no potential conflicts of interest.
Are Plasma Natriuretic Peptide Levels Influenced by Automatic Pacemaker Algorithms for Ventricular Pacing Minimization?
Article first published online: 10 JAN 2013
©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 4, pages 424–432, April 2013
How to Cite
KREUZER, J., LENNERZ, C., DIETL, J. U., BEIER, T., STRAUCH, A., SEMMLER, V., BADRAN, H., ZRENNER, B. and KOLB, C. (2013), Are Plasma Natriuretic Peptide Levels Influenced by Automatic Pacemaker Algorithms for Ventricular Pacing Minimization?. Pacing and Clinical Electrophysiology, 36: 424–432. doi: 10.1111/pace.12070
Funding source: The study was supported by Biotronik SE & Co KG (Woermannkehre 1, D-12359 Berlin, Germany).
- Issue published online: 2 APR 2013
- Article first published online: 10 JAN 2013
- Manuscript Accepted: 30 OCT 2012
- Manuscript Revised: 26 OCT 2012
- Manuscript Received: 11 MAY 2012
- Biotronik, Medtronic, Sorin, and St. Jude Medical
- Biotronik SE & Co KG (Woermannkehre 1, D-12359 Berlin, Germany)
- European Heart Rhythm Association
- pacemaker therapy;
- minimizing ventricular pacing;
- atrioventricular search hysteresis;
- natriuretic peptide;
Automatic atrioventricular search hysteresis (AVSH) is designed to reduce the cumulative percentage of potentially deleterious right ventricular apical pacing (VP%) in dual-chamber pacemakers. We investigated whether minimizing VP% by AVSH can, in turn, reduce ventricular wall stretching/stress, as assessed by plasma concentrations of the amino-terminal fragment of the pro-B-type natriuretic peptide (NT-proBNP).
After dual-chamber pacemaker implantation in 81 patients (age: 69 ± 11 years; males: 55.6%), the fixed atrioventricular delay of 225 ms was programmed and AVSH was turned off for 1 month. The patients were thereafter randomly assigned to standard AVSH for 1 month, followed by an enhanced AVSH for another month, or vice versa. At the 1-, 2-, and 3-month follow-ups, VP% values were retrieved from the pacemaker memory, and venous blood samples were taken for NT-proBNP measurements.
Both standard and enhanced AVSH reduced the median VP% value from 38.5% (for the fixed atrioventricular delay) to 2.1% (P < 0.001). However, plasma NT-proBNP concentrations for the fixed atrioventricular delay (median, 253 pg/mL), standard AVSH (225 pg/mL), and enhanced AVSH (276 pg/mL) did not differ significantly on the intrapatient basis (paired Wilcoxon tests) between any pair of these modalities.
Minimizing ventricular pacing by AVSH during 1 month had no influence on plasma NT-proBNP levels (i.e., ventricular wall stretching/stress) compared with a constant, moderately prolonged atrioventricular delay.