Wang Ruxing, Li Xiaorong, Jang Wenping, Liu Zhihua, Yang Xiangjun, Xiao Chunhui, Shao Lizheng, Zhu Jianqiu
Department of Cardiology, First People's Hospital of Wuxi City and First Affiliated Hospital of Nanjing Medical University in Wuxi, China.
Int Heart J. 2005 Nov;46(6):1015-22. doi: 10.1536/ihj.46.1015.
To observe blood B-type natriuretic peptide (BNP) level changes and the clinical implications in different periods and different cardiac pacing modes, the BNP levels of 105 patients with permanent cardiac pacing were assayed before pacemaker implantation and 1 day, 1 week, 1 month, 3 months, 6 months, and 9 months postoperatively. BNP level changes were compared in different periods and during different pacing modes. DDD(R) pacing mode was performed in 32 patients for 9 months and then changed to AAI(R) and VVI(R) pacing modes for 2 months, respectively. BNP levels were assayed during three different pacing modes. BNP levels did not change at any time with any pacing mode in patients with New York Heart Association (NYHA) heart functional class I to II before pacemaker implantation, however, BNP levels did change significantly with physiologic pacing mode and nonphysiologic pacing mode in patients with NYHA heart functional class III to IV before pacemaker implantation. BNP levels during physiologic pacing mode decreased significantly while it increased during nonphysiologic pacing mode. BNP levels were the lowest in AAI(R) pacing and the highest in VVI(R) pacing among the three pacing modes. The BNP level in DDD(R) pacing was between that for AAI(R) pacing and VVI(R) pacing. The results indicate that physiologic pacing should first be chosen in patients with bradycardia and congestive heart failure (CHF), and that AAI(R) was the best pacing mode if atrioventricular conduction function was normal.
为观察不同时期及不同心脏起搏模式下血B型利钠肽（BNP）水平变化及其临床意义，对105例永久性心脏起搏患者在起搏器植入前及术后1天、1周、1个月、3个月、6个月和9个月测定BNP水平。比较不同时期及不同起搏模式下BNP水平的变化。32例患者采用DDD（R）起搏模式9个月，然后分别改为AAI（R）和VVI（R）起搏模式2个月。在三种不同起搏模式下测定BNP水平。起搏器植入前纽约心脏协会（NYHA）心功能分级为Ⅰ至Ⅱ级的患者，无论何时采用何种起搏模式，BNP水平均无变化；然而，起搏器植入前NYHA心功能分级为Ⅲ至Ⅳ级的患者，其BNP水平在生理性起搏模式和非生理性起搏模式下有显著变化。生理性起搏模式下BNP水平显著降低，而非生理性起搏模式下则升高。三种起搏模式中，AAI（R）起搏时BNP水平最低，VVI（R）起搏时最高。DDD（R）起搏时的BNP水平介于AAI（R）起搏和VVI（R）起搏之间。结果表明，对于心动过缓合并充血性心力衰竭（CHF）患者应首选生理性起搏，若房室传导功能正常，AAI（R）是最佳起搏模式。
