title: Single-chamber ventricular pacing increases markers of left ventricular dysfunction compared with dual-chamber pacing.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Divsion of Cardiology, Department of Internal Medicine, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland. barbara.naegeli@triemli.stzh.ch
authors.forename: Barbara
authors.initials: B
authors.lastname: Naegeli
authors.forename: David J
authors.initials: DJ
authors.lastname: Kurz
authors.forename: David
authors.initials: D
authors.lastname: Koller
authors.forename: Edwin
authors.initials: E
authors.lastname: Straumann
authors.forename: Marcel
authors.initials: M
authors.lastname: Furrer
authors.forename: Dominik
authors.initials: D
authors.lastname: Maurer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Minder
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006327:Heart Block / Q000097:blood* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010138:Pacemaker, Artificial; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D012804:Sick Sinus Syndrome / Q000097:blood* / Q000628:therapy; D016037:Single-Blind Method; D018487:Ventricular Dysfunction, Left / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain