Author/Editor		Žižek, David; Lipar, Luka; Zupan, Igor; Rakovec, Peter; Klokočovnik, Tomislav
Title		Vpliv fizioloških dražljajev in nevrohumoralni odzivi pri preddvornoprekatni in sinhroni prekatni elektrostimulaciji srca
Translated title		DDD and single lead VDD pacing: evolution of posture, exercise and plasma nutriuretic peptide levels
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 74, št. Suppl 1
Publication year		2005
Volume		str. I-79-83
Language		slo
Abstract		Background. VDD pacing system is an alternative to DDD pacing system. Due to different fixation of electrodes in both systems, detected of atrial signal many vary greatly and can be influenced by posture and exercise. Inappropriate atrial sensing leads into loss of atrioventricular synchrony. Haemodynamic changes that occur have a distinctive influence on peripheral levels ANP and BNP. Methods. Our prospective study encompassed seventy-five patients with implanted VDD or DDD pacing system in year 2000. Using the programmer we directly measured sensing threshold in atrium supine, sitting upright and after standardized exercise. Among measured data we evaluated AV synchrony. Blood was collected from an antecubital vein and plasma proANP and NT-proBNP levels were measured. Results. Atrial sensing was significantly lower with VDD compared to DDD (p<0.001). The difference between supine and sitting upright among each pacing system was not significant (p=0.82). Atrial sensing was significantly lower after exercise compared to supine with VDD (p<0.05). VDD AV synchrony was lower (p<0.001). Difference of ANP levels was not significant (p=0.13). Levels of BNP were lower with VDD (p<0.05). Levels of ANP, BNP are negatively correlated to AV synchrony (o=-0.44, p<0.001 and o=-0.54, p<0.001, respectively). Levels of BNP and ANP are closely correlated (o=0.71, p<0,001). Conclusions. Posture did not have any significant effect on atrial sensing. However, in VDD pacing system atrial sensing was affected by exercise. Lower AV synchrony with VDD pacing system suggests lower haemodynamic support. Peripheral levels of natriuretic peptides were associated with AV synchrony. Therefore, haemodynamic affect can be predicted by measuring peripheral levels of either ANP or BNP.
Summary		Izhodišča. Sinhrona prekatna stimulacija (VDD) je alternativa sekvenčnemu preddvornoprekatnemu (DDD) načinu spodbujanja. Zaradi različne vsaditve elektrode pri obeh sistemih lahko pride do razlik v zaznavanju preddvora glede na položaj telesa in telesne obremenitve. V primeru slabega zaznavanja v preddvoru se izgubi preddvornoprekatna usklajenost. Hemodinamske spremembe, ki ob tem nastanejo, vplivajo na plazemsko raven hormonov ANP in BNP. Metode. V prospektivno raziskavo smo vključili 75 preiskovancev, ki so jim leta 2000 vsadili srčni spodbujevalnik tipa VDD ali DDD. S programatorjem smo neposredno določili prag zaznavanja v preddvoru leže, sede in po standardizirani obremenitvi in izmerili vrednosti preddvorneprekatne usklajenosti. Preiskovancem smo nato odvzeli vensko kri in določili koncentracije proANP in NT-proBNP. Rezultati. Zaznavanje v preddvoru je bilo pri VDD manjše kot pri DDD (p<0,001). Vendar so razlike med ležečim in sedečim položajem znotraj posameznega tipa stimulacije nepomembne (p=0,82). Pri VDD je prišlo do znižanja praga zaznavanja v preddvoru po obremenitvi glede na ležeč položaj (p<0,05). Pri VDD je bila preddvornoprekatna usklajenost manjša (p<0,001). Razlika v koncentraciji ANP ni bila značilna (p=0,13). Koncentracija BNP je bila pri tipu VDD manjša (p<0,05). Koncentracija ANP in BNP ter preddvornoprekatna usklajenost sta negativno povezani (o=-0,44, p<0,001 oziroma o=-0,54, p<0,001). Koncentraciji BNP in ANP sta tesno povezani (o=0,71, p<0,001). (Izvleček skrajšan na 2000 znakov)
Descriptors		CARDIAC PACING, ARTIFICIAL ELECTRODES, IMPLANTED HEART ATRIUM EXERCISE ATRIAL NATRIURETIC FACTOR PROSPECTIVE STUDIES