Europace Advance Access originally published online on February 1, 2007
Europace 2007 9(3):194-199; doi:10.1093/europace/eul186
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CARDIAC PACING
Single-chamber ventricular pacing increases markers of left ventricular dysfunction compared with dual-chamber pacing
1 Divsion of Cardiology, Department of Internal Medicine; 2 Zentrallabor, Stadtspital Triemli, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland
Aims Large randomized trials comparing DDD with VVI pacing have shown no differences in mortality, but conflicting evidence exists in regard to heart failure endpoints. Here we evaluated the effect of pacing mode on serum levels of brain natriuretic peptide (BNP) and amino-terminal-proBNP (NT-proBNP).
Methods Forty-one patients (age 73 ± 10 years) with dual-chamber pacemakers were included in a prospective, single-blind, randomized crossover study evaluating the impact of DDD(R)/VDD versus VVI(R) mode on objective and functional parameters. Data were collected after a 2-week run-in phase and after 2 weeks each of VVI(R) and DDD(R)/VDD pacing or vice versa.
Results BNP and NT-proBNP levels during DDD(R)/VDD stimulation (151 ± 131 and 547 ± 598 pg/mL) showed no change compared with baseline (154 ± 130 and 565 ± 555 pg/mL), but a significant 2.4-fold increase was observed during VVI(R) mode [360 ± 221 and 1298 ± 1032 pg/mL; P < 0.001 compared with DDD(R)/VDD]. The assessment of functional class, the presence of pacemaker syndrome [49% in VVI(R) mode] and the patients' preferred pacing mode showed significant differences in favour of DDD(R)/VDD pacing.
Conclusion Patients can differentiate between DDD(R)/VDD and VVI(R) pacing, and prefer the former. Compared with DDD(R)/VDD pacing, VVI(R) stimulation induces a two- to three-fold increase in serum BNP and NT-proBNP levels.
Key Words: Pacing, Natriuretic peptides, Pacemaker syndrome, Echocardiography
* Corresponding author. Tel: +41 44 466 11 11; fax: +41 44 466 25 99. E-mail address: barbara.naegeli{at}triemli.stzh.ch
Manuscript submitted 6 June 2006. Accepted after revision 10 November 2006.
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  Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur. Heart J., October 1, 2008; 29(19): 2388 - 2442. [Full Text] [PDF]
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 K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur J Heart Fail, October 1, 2008; 10(10): 933 - 989. [Full Text] [PDF]
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