Does permanent cardiac stimulation through atrial natriuretic peptide secretion influence the basic parameters of renal function?
BACKGROUND
The aim of this study was to evaluate atrial humoral function and renal function after pacemaker implantation due to atrioventricular conduction disturbances. We analyzed blood atrial natriuretic peptide (ANP) concentration and basic parameters of renal function within 1 month of implantation of VVI and DDD pacemakers. We evaluated correlations between blood ANP values and basic renal function parameters.


METHODS
We studied two groups of patients with atrioventricular (AV) conduction disturbances: second-degree AV block and third-degree AV block. Group I comprised 20 patients aged 71-90 years (median 77.5 +/- 5.9 years) in whom permanent VVI pacing was applied, and group II consisted of 20 subjects aged 49-81 years (median 68.9 +/- 11.9 years) in whom DDD/ /VDD pacemakers were implanted. The control group consisted of 15 healthy volunteers aged 58-80 years (median 72.7 +/- 2.8 years). Plasma concentration of ANP was determined by radioimmunoassay. The parameters of renal function we analyzed with Jaffe's colorimetric and kinetic test.


RESULTS
Patients in group I showed a significant decrease in blood concentration of ANP from 168.1 +/- 81.9 pg/1000 mL to 118.0 +/- 61.1 pg/1000 mL (p < 0.01) 7 days after implantation. At 30 days, ANP was 121.4 +/- 71.9 pg/1000 mL. In group II, plasma concentration of ANP decreased significantly from 134.9 +/- 8.1 pg/1000 mL to 104.9 +/- 6.1 pg/1000 mL (p < 0.01) 7 days after implantation and to 110.8 +/- 53.3 pg/1000 mL at 30 days. Patients in group I had elevated, albeit insignificantly, clearance of creatinine to 76.1 +/- 17.8 ml/min at 7 days (p > 0.05) which increased significantly to 85.0 +/- 17.9 ml/min at 30 days. In group II, clearance of creatinine increased insignificantly to 84.6 +/- 13.2 ml/min (p < 0.05) at 7 days and was significantly elevated to 96.9 +/- 18.2 ml/min (p < 0.05) at 30 days. In group I, plasma concentration of creatinine decreased significantly (p < 0.05) to 1.15 +/- 0.30 mg/dl at 7 days and to 1.01 +/- +/- 0.21 mg/dl at 30 days. In group II, there was a significant decrease (p < 0.05) to 1.15 +/- 0.24 mg/dl at 7 days and to 1.08 +/- 0.27 mg/dl at 30 days. There was a positive correlation between creatinine clearance and plasma ANP concentration in groups I and II (r = 0.301; p < 0.05).


CONCLUSIONS
In patients with a pacemaker implanted due to atrioventricular disturbances, blood concentration of ANP was decreased. Renal function was improved after pacemaker implantation. (Cardiol J 2007; 14: 568-572).
Sielski
Janusz
J
Janion
Marianna
M
Gawor
Zenon
Z
Bobiarski
Jerzy
J
Ciuraszkiewicz
Katarzyna
K