natriuretic-peptide--brain and Atrioventricular-Block

To investigate the long-term effect of biventricular (BIV) and right ventricular apical (RVA) pacing on cardiac function in patients with high-degree atrioventricular block (AVB) and left ventricular ejection fraction(LVEF)over 35%.. A total of 118 consecutive patients with high-degree AVB in six hospitals from East China between May 2009 and December 2012 were enrolled in this randomized, double-blind and parallel controlled study. Patients were randomly assigned to BIV and RVA pacing with or without LV lead on after one-week cardiac resynchronization therapy (CRT). Cardiac function including New York Heart Association(NYHA), 6 minute walking distance (6MWD), Minnesota living with heart failure (MLHF) score, LVEF, left ventricular end-diastolic volumes/diameters (LVEDV/LVEDD) and other echocardiography parameters, as well as N-terminal pro-B-type natriuretic peptide (NT-proBNP)were assessed at 6 months and 12 months.. A total of 114 patients were successfully implanted with CRT. Cardiac function was significantly improved after one-week BIV pacing (n=57) compared with pre-CRT: rate of patients with NYHA Ⅲ (25.44%(29/114) vs. 9.65%(11/114)), MLHF score (17.1±13.6 vs. 26.9±21.6), 6MWD ((315.4±121.8)m vs. (291.8±102.9)m) and NT-proBNP (157.0(70.0, 639.0) ng/L vs. 444.7(144.0, 1 546.0)ng/L, all P<0.05). In BIV group, 6MWD extended from (314.8±142.7)m to (332.7±117.5)m at 6 months (P<0.05), LVEF increased from (60.7±7.9)% at 1 week to (56.6±10.7)% at 6 months(P<0.05), both LVEDV and LVEDD decreased at 12 months compared with at 1 week ((116.2±39.5)ml vs. (131.4±49.6)ml and (50.2±5.6)mm vs. (52.5±6.8)mm, P<0.05). In RVA group (n=57), 6MWD increased at 6 months compared that at 1week ((342.4±109.9)m vs. (310.2±105.1)m, P<0.05), NT-proBNP was higher at 12 months than that at 1 week (349.5(191.8, 884.3)ng/L vs. 127.0(70.3, 336.7)ng/L, P<0.05). Compared with RVA group, BIV group had a bigger shrink in LVEDV decrease at 12 months was more significant in BIV group ((-16.68±24.30)ml vs. (9.09±29.30)ml, P<0.05).. Cardiac pacing could acutely improve the cardiac function in patients with high-degree AVB and LVEF over 35%. Improvements on cardiac function and remodeling are more significant after 12-month BIV pacing than that of RVA pacing. Clinical Trail Registry: Chinese Clinical Trial Registry, ChiCTR-TRC-10000832.

Topics: Atrioventricular Block; Cardiac Resynchronization Therapy; China; Double-Blind Method; Echocardiography; Heart Failure; Heart Ventricles; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Stroke Volume; Treatment Outcome; Ventricular Function, Left

Dual chamber pacing is known to have detrimental effect on cardiac performance and heart failure occurring eventually is associated with increased mortality. Experimental studies of pacing in dogs have shown contractile dyssynchrony leading to diffuse alterations in extracellular matrix. In parallel, studies on experimental ischemia/reperfusion injury have shown efficacy of valsartan to inhibit activity of matrix metalloproteinase-9, to increase the activity of tissue inhibitor of matrix metalloproteinase-3 and preserve global contractility and left ventricle ejection fraction.. To present rationale and design of randomized blinded trial aimed to assess whether 12 month long administration of valsartan will prevent left ventricle remodeling in patients with preserved left ventricle ejection fraction (LVEF ≥ 40%) and first implantation of dual chamber pacemaker.. A total of 100 eligible patients will be randomized into three parallel arms: placebo, valsartan 80 mg/daily and valsartan 160 mg/daily added to previously used drugs. The primary endpoint will be assessment of valsartan efficacy to prevent left ventricle remodeling during 12 month follow-up. We assess patients' functional capacity, blood plasma activity of matrix metalloproteinases and their tissue inhibitors, NT-proBNP, tumor necrosis factor alpha, and Troponin T. Left ventricle function and remodeling is assessed echocardiographically: M-mode, B-mode, tissue Doppler imaging.. If valsartan proves effective, it will be an attractive measure to improve long term prognosis in aging population and increasing number of pacemaker recipients. ClinicalTrials.org (NCT01805804).

Topics: Atrioventricular Block; Dose-Response Relationship, Drug; Double-Blind Method; Echocardiography; Humans; Matrix Metalloproteinases; Natriuretic Peptide, Brain; Pacemaker, Artificial; Peptide Fragments; Research Design; Stroke Volume; Tumor Necrosis Factor-alpha; Valsartan; Ventricular Remodeling

Previous studies showed unfavourable effects of right ventricular (RV) pacing. Ventricular pacing (VP), however, is required in many patients with atrioventricular (AV) block. The PREVENT-HF study explored left ventricular (LV) remodelling during RV vs. biventricular (BIV) pacing in AV block without advanced heart failure. The pre-specified PREVENT-HF German Substudy examined exercise capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP).. Patients with expected VP ≥80% were randomized to RV or BIV pacing. Endpoints were peak oxygen uptake (pVO2), oxygen uptake at the anaerobic threshold (VO2AT), ventilatory efficiency (VE/VCO2), and logNT-proBNP. Considering crossover, intention to treat (ITT), and on-treatment (OT) analyses of covariance (ANCOVA) were performed. For exercise testing 44 (RV: 25, BIV: 19), and for NT-proBNP 53 patients (RV: 29, BIV: 24) were included. The ITT analysis revealed significant differences in pVO2 [ANCOVA effect 2.83 mL/kg/min, confidence interval (CI) 0.83-4.91, P = 0.007], VO2AT (ANCOVA effect 2.14 mL/min/k, CI 0.14-4.15, P = 0.03), and VE/VCO2 (ANCOVA effect -5.46, CI -10.79 to -0.13, P = 0.04) favouring BIV randomization. The significant advantage in pVO2 persisted in OT analysis, while VO2AT and VE/VCO2 showed trends favouring BIV pacing. LogNT-proBNP did not differ between groups. (ITT: ANCOVA effect 0.008, CI -0.40 to +0.41, P = 0.97; OT: ANCOVA effect -0.03, CI -0.44 to 0.30, P = 0.90).. Our study suggests that BIV pacing produces better exercise capacity over 1 year compared with RV pacing in patients without advanced heart failure and AV block. In contrast, we observed no significant changes of NT-proBNP. Larger trials will allow appraising the clinical usefulness of BIV pacing in AV block. ClinicalTrials.gov Identifier: NCT00170326.

Topics: Aged; Atrioventricular Block; Biomarkers; Cardiac Resynchronization Therapy Devices; Exercise Test; Exercise Tolerance; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Recovery of Function; Treatment Outcome

We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function.. Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit.. Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% (for all comparisons, P<0.05). However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold.. RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.

Topics: Aged; Atrioventricular Block; Biomarkers; Cardiac Pacing, Artificial; Female; Heart Ventricles; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Treatment Outcome; Ventricular Dysfunction, Left

Whether right ventricular outfow tract septum (RVOTS) pacing is superior to right ventricular apex (RVA) pacing with respect to left ventricular synchrony, cardiac function, and remodelling in the elderly with normal left ventricular ejection fraction (LVEF), is still unknown.. To assess the impact of RVOTS vs. RVA pacing on the cardiac performance of the elderly with normal LVEF during a long-term observation.. From 2007 to 2010, 65 patients with standard pacing indications for permanent pacing were recruited and randomised to receive RVA (32 patients) or RVOTS pacing (33 patients). Over a median 28 months' follow-up, available data was summarised, including New York Heart Association (NYHA) functional class, echocardiographic and pacing parameters, axis, QRS duration and plasma B-type natriuretic peptide (BNP) level. Then these values were compared between the RVA group and the RVOTS group, as well as between pacemaker pre- and post-implantation in the RVA group and in the RVOTS group, respectively.. There were no significant differences in baseline characteristics between the RVA group and the RVOTS group. The median pacing durations did not differ significantly between the groups (31.5 months in the RVA group vs. 28 months in the RVOTS group, p = 0.728). Compared to the baseline values, LVEF decreased with RVA pacing (from 59.5 ± 6.21 to 54.22 ± 8.73, p = 0.001), but LVEF did not markedly vary in the RVOTS group (57.82 ± 6.06 and 56.94 ± 5.54, p = 0.152). The number of patients with moderate tricuspid valve regurgitation remarkably increased in the RVA group, from six (18.75%) patients to 10 (31.3%) patients, preoperatively to postoperatively (p = 0.046), but this change was not statistically significant in the RVOTS group. Compared to the RVOTS group, NYHA functional class had a deteriorated tendency in the RVA group (p = 0.071). After the implantation, the increase of median BNP level was observed in the RVA group (35 pg/mL at preimplantation and 50 pg/mL at the end of follow-up, p = 0.007); No significant change was obtained in the RVOTS group (36.4 pg/mL at pre-implantation vs. 38 pg/ml at the end of follow-up, p = 0.102). Compared to the RVA pacing group, the mean QRS width narrowed substantially in the RVOTS pacing group (from 143.56 ± 12.90 to 105.52 ± 15.21, p = 0.000). In terms of the end diastolic and systolic diameters of the left ventricular, there were no statistical variations observed during the follow-up.. Permanent RVA pacing in elderly patients with normal LVEF led to left ventricular systolic function deterioration denoted by lower LVEF and higher BNP level. When compared to RVA pacing, RVOTS pacing had no remarkable benefit in terms of preventing cardiac remodelling.

Topics: Aged; Aged, 80 and over; Atrioventricular Block; Cardiac Pacing, Artificial; Echocardiography; Electrocardiography; Electrodes; Equipment Failure Analysis; Female; Follow-Up Studies; Heart Failure; Heart Ventricles; Humans; Male; Natriuretic Peptide, Brain; Pacemaker, Artificial; Prospective Studies; Sick Sinus Syndrome; Stroke Volume; Systole; Tricuspid Valve Insufficiency; Ventricular Septum

We aimed to investigate whether biventricular (BiV) pacing minimizes left ventricular (LV) dyssynchrony and preserves LV ejection fraction (LVEF) as compared with standard dual-chamber DDD(R) pacing in consecutive patients with high-grade atrio-ventricular (AV) block.. Fifty patients were randomized to DDD(R) pacing or BiV pacing. LVEF was measured using three-dimensional echocardiography. Tissue-Doppler imaging was used to quantify LV dyssynchrony in terms of number of segments with delayed longitudinal contraction (DLC). LVEF was not different between groups after 12 months (P = 0.18). In the DDD(R) group LVEF decreased significantly from 59.7(57.4-61.4)% at baseline to 57.2(52.1-60.6)% at 12 months of follow-up (P = 0.03), whereas LVEF remained unchanged in the BiV group [58.9(47.1-61.7)% at baseline vs. 60.1(55.2-63.3)% after 12 months (P = 0.15)]. Dyssynchrony was more prominent in the DDD(R) group than in the BiV group at baseline (2.2 +/- 2.2 vs. 1.4 +/- 1.3 segments with DLC per patient, P = 0.10); and at 12 month follow-up (1.8 +/- 1.9 vs. 0.8 +/- 0.9 segments with DLC per patient, P = 0.02). NT-proBNP was unchanged in the DDD(R) group during follow-up (122 +/- 178 pmol/L vs. 91 +/- 166 pmol/L, NS) but decreased significantly in the BiV-group (from 198 +/- 505 pmol/L to 86 +/- 95 pmol/L after 12 months, P = 0.02).. BiV pacing minimizes LV dyssynchrony, preserves LV function, and reduces NT-proBNP in contrast to DDD(R) pacing in patients with high-grade AV block.

Topics: Aged; Aged, 80 and over; Atrioventricular Block; Cardiac Pacing, Artificial; Echocardiography, Three-Dimensional; Electrocardiography; Female; Heart Atria; Heart Ventricles; Humans; Male; Natriuretic Peptide, Brain; Pacemaker, Artificial; Peptide Fragments; Stroke Volume; Ventricular Dysfunction, Left

Atrial synchronous right ventricular pacing (VP) may compromise ventricular function in patients undergoing pacemaker implantation for atrioventricular block. We assessed the usefulness of tissue Doppler imaging (TDI) and color M-mode echocardiography in evaluating patients with VP, and examined the long-term effects of VP on ventricular function by echocardiographic indices and B-type natriuretic peptide (BNP) measurements.. We studied 60 clinically stable elderly dual-chamber pacemaker recipients (mean age: 74 +/- 9 years) who had normal left ventricular (LV) systolic function and on the long term the same cardiac rhythm, either intrinsic normal ventricular activation (IA) (n = 20), or VP (n = 40).. Paced patients, compared to patients with IA, had decreased stroke volume (p < 0.05) and a more depressed relaxation pattern, as indicated by decreased peak early mitral velocity (E)/peak atrial contraction velocity ratio and tissue Doppler imaging (TDI)-early transmitral diastolic velocity (Ea) measures (p < 0.05). Both groups presented similar BNP levels and LV filling pressures, as assessed by E/Ea and E/early diastolic transmitral flow propagation velocity. In VP patients, age (beta = 0.31), Ea (beta = -0.28) and E/Ea (beta = 0.32) emerged as independent predictors of BNP levels.. VP is associated with reduced LV systolic function and signs of impaired relaxation. Elevated BNP levels in elderly VP patients with normal ejection fraction may be predicted by TDI signs of LV diastolic dysfunction.

Topics: Aged; Atrioventricular Block; Cardiac Pacing, Artificial; Diastole; Echocardiography, Doppler; Female; Heart Atria; Humans; Male; Natriuretic Peptide, Brain; Stroke Volume; Systole; Ventricular Dysfunction; Ventricular Function

Topics: Atrioventricular Block; Biopsy; Cardiomyopathies; Diagnosis, Differential; Disease Progression; Echocardiography; Fluorodeoxyglucose F18; Giant Cells; Granuloma; Heart Block; Heart Failure; Heart Transplantation; Humans; Lymph Nodes; Magnetic Resonance Imaging; Male; Middle Aged; Myocarditis; Myocardium; Natriuretic Peptide, Brain; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sarcoidosis; Stroke Volume; Troponin I

There are a few children with isolated congenital complete atrioventricular block (ICCAVB) who do not require a pacemaker. We report a female infant born at 36 weeks by emergency cesarean section because of fetal heart rate abnormalities who was diagnosed as having ICCAVB. In accordance with the echocardiographic findings, we simultaneously measured the cardiothoracic ratio (CTR) by chest radiography and serum N-terminal pro-BNP (NT-proBNP) and have continued to follow her as an outpatient for about 8 years. CTR and NT-proBNP showed strong positive correlation (r=0.894, p<0.05). In such few children with ICCAVB as this patient, CTR measurement during their follow-up would be very useful to easily understand their cardiac load status.

Topics: Adult; Atrioventricular Block; Female; Follow-Up Studies; Humans; Infant, Newborn; Natriuretic Peptide, Brain; Peptide Fragments; Pregnancy; Radiography, Thoracic

Our aim is to clarify the factors for early diagnosis of cardiac sarcoidosis (CS) in patients with complete atrioventricular block (CAVB) and its impact on cardiac function after corticosteroid therapy.A total of 15 CS patients with CAVB who underwent corticosteroid therapy were retrospectively analyzed. Patients were divided into two groups according to the time from the first CAVB onset to the diagnosis of CS. Clinical characteristics and outcomes were compared between the early diagnosis group (within 1 year; group E, n = 10) and the late diagnosis group (over 1 year; group L, n = 5).The history of extracardiac sarcoidosis (60 versus 0%, P = 0.0440) and abnormal findings on echocardiography (70 versus 0%, P = 0.0256) at the CAVB onset were significantly more frequent in group E than in group L. The change of left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) levels was significantly better in group E than in group L (0.8 ± 2.8 versus -32.4 ± 3.9%, P < 0.0001; -11.1 ± 16.0 versus 161.8 ± 35.8 pg/mL, P = 0.0013, respectively). After corticosteroid therapy, the LVEF and BNP levels were also significantly better in group E than in group L (53.3 ± 10.7 versus 37.0 ± 9.3%, P = 0.0128; 63.0 ± 46.4 versus 458.8 ± 352.0 pg/mL, P = 0.0027).The diagnosis may be delayed in CS patients with CAVB without history of extracardiac sarcoidosis. Abnormal findings on echocardiography contributed to the early diagnosis of CS. Therefore, the diagnosis of CS may be missed or delayed in patients without them. Time delay from the CAVB onset to the CS diagnosis may exacerbate the cardiac function.

Topics: Adult; Atrioventricular Block; Cardiomyopathies; Diagnostic Errors; Early Diagnosis; Echocardiography; Electrocardiography; Female; Glucocorticoids; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Retrospective Studies; Sarcoidosis; Stroke Volume; Ventricular Function, Left

N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations may be increased in cats with various cardiac disorders. The point-of-care (POC) ELISA assay uses the same biologic reagents as the quantitative NT-proBNP ELISA. Previous studies have evaluated the sensitivity and specificity of the POC ELISA in cats with cardiac disease.. To prospectively evaluate the diagnostic utility of the POC ELISA in a select population of cats.. Thirty-eight client-owned cats presented to the University of Florida Cardiology Service for cardiac evaluation. Fifteen apparently healthy cats recruited as part of another study.. Physical examination and echocardiography were performed in all cats. The POC ELISA was assessed visually as either positive or negative by a reader blinded to the echocardiographic findings, and results were analyzed relative to quantitative assay results.. Twenty-six cats were diagnosed with underlying cardiac disease, and 27 cats were considered free of cardiac disease. Cats with cardiac disease included: 21 with hypertrophic cardiomyopathy, 2 with unclassified cardiomyopathy, 2 with restrictive cardiomyopathy, and 1 with 3rd degree atrioventricular (AV) block. The POC ELISA differentiated cats with cardiac disease with a sensitivity of 65.4% and specificity of 100%.. The POC NT-proBNP ELISA performed moderately well in a selected population of cats. A negative test result cannot exclude the presence of underlying cardiac disease, and a positive test result indicates that cardiac disease likely is present, but further diagnostic investigation would be indicated for a definitive diagnosis.

Topics: Animals; Atrioventricular Block; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Case-Control Studies; Cat Diseases; Cats; Enzyme-Linked Immunosorbent Assay; Female; Heart Diseases; Male; Natriuretic Peptide, Brain; Peptide Fragments; Point-of-Care Systems; Sensitivity and Specificity

Takotsubo cardiomyopathy (TC) is an acute cardiac syndrome characterized by transient left ventricular dysfunction and relatively good prognosis after discharge. However, cardiac complications during hospitalization remain to be fully determined. We attempted to determine features characterizing patients with adverse clinical outcome by comparing those with cardiac complication and without cardiac complication during hospitalization.. We investigated 107 patients with TC from the Tokyo CCU Network database, comprising 67 cardiovascular centers in the metropolitan area during January 1 to December 31, 2010. Cardiac complications were defined as cardiac death, pump failure (Killip grade≥II), sustained ventricular tachycardia or fibrillation (SVT/VF), and advanced atrioventricular block (AVB). Cardiac complications were observed in 41 patients (37 pump failure complicated by 3 cardiac deaths and 2 SVT/VF and 2 AVB without pump failure), and there was no cardiac complication in the remaining 66 patients. There was no difference in age, peak creatinine kinase level, C-reactive protein level and ST elevation on electrocardiogram. Multiple logistic regression analysis showed that white blood cell count (p=0.039) and brain natriuretic peptide (p=0.001) were independent predictors of in-hospital adverse cardiac complications.. Cardiac complications are relatively high in patients with TC during hospitalization. High white blood cell count and brain natriuretic peptide level are associated with poor clinical outcome in patients with TC.

Topics: Aged; Aged, 80 and over; Atrioventricular Block; Biomarkers; Coronary Care Units; Death, Sudden, Cardiac; Female; Forecasting; Heart Failure; Hospitalization; Humans; Leukocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Registries; Tachycardia, Ventricular; Takotsubo Cardiomyopathy; Time Factors; Tokyo; Ventricular Fibrillation

Although brain natriuretic peptide (BNP) levels are shown to be an important prognostic factor in patients with acute myocardial infarction (MI), the relationship between arrhythmias and BNP levels is not known. This study assessed whether baseline clinical factors, N-terminal-proBNP (NT-proBNP) levels and electrocardiographic patterns of acute inferior MI are associated with greater risk of developing complete atrioventricular block (CAVB) and mortality.. Seventy-nine consecutive patients (52 male, 27 female with an avarage age of 64.2 ± 10.9 years) with CAVB and 119 control patients (93 male, 16 female with an average age of 57.7 ± 11.4 years) without CAVB were enrolled. Regression analysis revealed that NT-proBNP levels 〉 104 pg/mL increased the development of CAVB by 16.7 folds, 〉 1 mm ST elevation in RV4 by 2.7 folds, ratio of elevation in lead III:II 〉 1.5 by 10.1 folds but the thrombolytic therapy decreased the development of CAVB by 2.8 folds. NT-proBNP 〉 92 pg/mL increased the mortality by 8.9 folds, a ratio of ST-segment elevation in lead III:II 〉 1 by 3.1 folds, ST segment elevation 〉 1 mm in RV4 by 3.5 folds, ejection fraction 〈 35% by 24.2 folds, age 〉 65 years by 8.3 folds and CAVB by 6.8 folds, on contrary thrombolytic treatment decreased the mortality by 3.3 folds.. Simple electrocardiographic measurements and NT-proBNP levels at admission can be used as a screening test for development of complications such as CAVB, right ventricular involvement and mortality during acute inferior wall MI.

Topics: Age Factors; Aged; Atrioventricular Block; Biomarkers; Chi-Square Distribution; Electrocardiography; Female; Hospital Mortality; Humans; Inferior Wall Myocardial Infarction; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Risk Assessment; Risk Factors; Thrombolytic Therapy; Up-Regulation; Ventricular Function, Right

Topics: Atrioventricular Block; Cardiac Pacing, Artificial; Female; Humans; Male; Natriuretic Peptide, Brain; Sick Sinus Syndrome

Cardiac resynchronization therapy (CRT) has been proven its value in adult patients with congestive heart failure of low ejection fraction and wide QRS duration. Contrast to adult patients, CRT has been rarely applied for young patients. We report on a 9-yr-old boy with progressive left ventricular (LV) dilatation and dysfunction following chronic VVI pacemaker therapy for congenital complete atrioventricular block associated with maternal anti-SSA/Ro and SSB/La antibody. His LV dysfunction was improved after epicardially established CRT.

Topics: Antibodies, Antinuclear; Atrioventricular Block; Cardiac Pacing, Artificial; Cardiac Resynchronization Therapy; Child; Chronic Disease; Electrocardiography; Heart Ventricles; Humans; Male; Natriuretic Peptide, Brain; Radiography; Sjogren's Syndrome; Ventricular Dysfunction, Left

Stabilization of the cardiovascular system is maintained by variations in hemodynamic and hormonal parameters in complete atrioventricular (AV) block. We investigated the variations in hemodynamic parameters and brain natriuretic peptide (BNP) levels before and after permanent pacemaker implantation for complete AV block.. We evaluated 25 patients (14 men, 11 women; mean age 72+/-10 years; range 39 to 83 years) who presented with a complaint of syncope due to complete AV block. All the patients were hemodynamically stable on presentation and were monitored in the coronary care unit until permanent pacemaker implantation. Variations in the cardiovascular system were determined before and two weeks after pacemaker implantation, including mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR), systemic aortic compliance (SAC), and BNP levels.. The mean heart rates were 36+/-6 beat/min and 65+/-10 beat/min before and after pacing, respectively. Compared to the pacing period, CO was significantly lower (p<0.001) and SVR was significantly higher (p=0.001) before pacemaker implantation, suggesting a compensatory rise in SVR. The mean arterial pressure did not show a significant difference and remained within normal ranges before and after pacing. There were no significant differences in SV, SAC, and BNP levels before and after pacemaker implantation, with BNP exhibiting increased levels in both periods.. While no compensatory alterations occur in SV, SAC, and BNP before and after pacemaker implantation, decreased CO in complete AV block seems to be balanced by increased SVR, which results in maintenance of MAP within the normal range.

Topics: Adult; Aged; Aged, 80 and over; Atrioventricular Block; Blood Pressure; Cardiac Output; Female; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pacemaker, Artificial; Stroke Volume; Vascular Resistance

B-type natriuretic peptide (BNP) was measured in 43 children and adolescents with high-grade second degree or complete atrioventricular conduction block. BNP plasma level was significantly higher (p<0.01) in patients without pacemaker (n=21) than in patients with permanent pacemaker (n=26). In all four patients with measurement of BNP both before and after placement of a permanent pacemaker, individual plasma BNP decreased. Additionally, patients with dual-chamber pacing had significantly lower BNP values compared to those with single chamber ventricular pacing (p<0.05). Conclusively, high degree atrioventricular block can induce elevated plasma BNP levels and the loss of atrioventricular synchrony induce a further increase of plasma BNP.

Topics: Adolescent; Atrioventricular Block; Biomarkers; Child; Child, Preschool; Female; Humans; Infant; Male; Natriuretic Peptide, Brain; Young Adult