Lo Bianco F, Altamura G, Bianconi L, Toscano S, Pandozi C, Castro A, Magliocca V, Gentilucci G, Magris B, Santini M
Dipartimento delle Malattie del Cuore, Ospedale San Filippo Neri, Roma.
G Ital Cardiol. 1997 Oct;27(10):1019-23.
Atrial natriuretic factor (ANF) is a peptide produced by the atrium in response to increases in atrial pressure. It is a potent vasodilator and recent studies suggest that ANF may modulate vasomotor changes in patients (pts) with pacemaker (PM) syndrome. To evaluate the incidence of pacing mode on peptide secretion, plasma concentrations of ANF were determined in 32 pts (18 men and 14 women, mean age 71 +/- 4 years) with a DDD PM implant. Blood samples were collected one hour after a randomly assigned PM programming either in VVI or DDD mode at 70 ppm. Mean plasma ANF levels were 84.12 +/- 51 pg/ml in DDD mode and 156.0 +/- 15 pg/ml in VVI mode (p < 0.05). In 12 pts presenting ventriculoatrial retroconduction, the ANF levels were 77.16 +/- 50 pg/ml during DDD stimulation and 219.0 +/- 16 pg/ml during VVI stimulation (p < 0.05). ANF level was 88.50 +/- 46 pg/ml in DDD mode and 114.25 +/- 65 pg/ml in VVI mode in the 20 pts without AV retroconduction (p < 0.05). During DDD mode, 18 patients showed a DVI stimulation whereas 14 showed a VDD stimulation: the mean ANF level was 67.40 +/- 15 pg/ml during DVI and 100.40 +/- 28 pg/ml during VDD stimulation; the difference between these data was not significant. The increase in ANF levels during VVI pacing confirms the lower haemodynamic performance of this stimulation mode. The increase of ANF levels during VVI stimulation, which was in the subgroup without AV retroconduction, confirms the benefits of DDD stimulation also in this group of patients as well. Atrial pacing at physiological rates does not trigger the release of ANF.
心房利钠因子（ANF）是心房在心房压力升高时产生的一种肽。它是一种强效血管扩张剂，最近的研究表明，ANF可能调节起搏器（PM）综合征患者的血管舒缩变化。为了评估起搏模式对肽分泌的影响，对32例植入双腔起搏器（DDD PM）的患者（18例男性和14例女性，平均年龄71±4岁）测定了血浆ANF浓度。在以70次/分钟的频率随机分配为VVI或DDD模式进行起搏器程控1小时后采集血样。DDD模式下平均血浆ANF水平为84.12±51 pg/ml，VVI模式下为156.0±15 pg/ml（p<0.05）。在12例存在室房逆向传导的患者中，DDD刺激时ANF水平为77.16±50 pg/ml，VVI刺激时为219.0±16 pg/ml（p<0.05）。在20例无房室逆向传导的患者中，DDD模式下ANF水平为88.50±46 pg/ml，VVI模式下为114.25±65 pg/ml（p<0.05）。在DDD模式下，18例患者表现为DVI刺激，14例表现为VDD刺激：DVI刺激时平均ANF水平为67.40±15 pg/ml，VDD刺激时为100.40±28 pg/ml；这些数据之间的差异无统计学意义。VVI起搏时ANF水平的升高证实了这种刺激模式较低的血流动力学性能。在无房室逆向传导的亚组中，VVI刺激时ANF水平的升高也证实了DDD刺激对该组患者同样有益。以生理频率进行心房起搏不会触发ANF的释放。
