心房起搏电极刺激对血NT-proBNP与左心功能的影响

Influence of the Atrial pacing stimulation to Left Heart Function and NT-proBNP

目的观察起搏器心房电极电流刺激对心房分泌氨基末端脑钠肽前体(N-terminal probrain natriuretic peptide,NT-pro BNP)及心功能的影响。方法共纳入95例入选者均为窦性心动过缓,植入双腔起搏器(DDD)。术后均设置DDD模式;术后3月程控为VDD模式,观察期10 d。分别于程控前及观察期后检测血NT-pro BNP,同期行心脏多普勒超声测量:左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)的变化。结果采用VDD模式10 d后,NT-pro BNP值较前明显减少[110.36(94.61,197.11)ng/L vs.94.36(86.32,128.36)ng/L,P<0.01];患者LVEF值较前减小[(55.47±6.10)%vs.(51.27±5.68)%,P=0.03];LAD值[29.80(26.55,33.05)mm vs.30.50(26.80,35.80)mm,P=0.09]和LVEDD值[48.60(46.25,50.50)mm vs.48.80(47.55,53.65)mm,P=0.12]呈增加趋势。结论双腔起搏器患者心房电极起搏对心房分泌NT-pro BNP有促进作用,对患者心功能改善具有积极影响。

Objective To observe the influence of the current stimulation of atrial electrodes from a pacing on the N-terminal pro-brain natriuretic peptide（NT-pro BNP） and cardiac function and structure. Methods All selected cases were checked, in accordance with permanent pacemaker implantation class I or class type IIa indications. Atrial electrodes are implanted into the right atrium, while the ventricle electrode is in the right ventricular inlet septum. Atrioventricular all-around pacemaker mode（atrial pacemaker electrode, Group DDD） is set at postoperative period; atrial synchronous ventricular inhibition mode（atrial electrode of pacemaker, Group VDD） is on three months after the operation with 10-days observation period. Detecting the blood NT- pro BNP before the adjustment, after the observation period respectively, after the observation period respectively and at the same using the intracoronary Doppler ultrasound to measure the following： left atrium diameter（LAD）, left ventricular end-diastolic diameter（LVEDD）, left ventricular end systolic diameter（LVESD） and left ventricular ejection fraction（LVEF）. To ensure patients＇ safety and the accuracy of the result, the ventricular pacing at the low limit frequency of 45 times/min is set after shutting down the atrial pacing electrode, and the pacing equal or greater than 40% during the observation period is not in our research any more. A total of 95 people participate in our research via the self-contrast method. Results After shutting down the atrial electrode, the NT-pro BNP values are reduced accordingly [（94.61,197.11）ng/L vs.（86.32,128.36）ng/L,P=0.00]; LVEF values of patients decrease after the observation period from the previous [（55.47±6.10）% vs.（51.27±5.68）%,P=0.03]; The LAD Values[（26.55,33.05）mm vs.（26.80,35.80）mm, P=0.09]and the LEVDD Values[（46.25,50.50）mm vs.（47.55,53.65）mm, P=0.12] increase from the previous. Conclusion The double chamber pacemaker inserted on the patient has a promoting effect on the NT-pro BNP secreted by the atrium while the atrial electrode is working, which could play a positive role in improving the cardiac function of patients.