Brain natriuretic peptide: a marker of cardiac dysfunction with ventricular or dual-chamber pacing.

BACKGROUND/OBJECTIVES: The inability of trials to exhibit the superiority in survival of atrioventricular compared to ventricular pacing can be partially explained by the apical stimulation of the right ventricle, which adversely affects both short- and long-term ventricular performance. We evaluated the impact of pacing mode (DDDR vs. VVIR) on the brain natriuretic peptide (BNP) level in patients with sick-sinus syndrome (SSS). METHODS: Sixty-seven patients were treated with DDDR pacemaker implantation due to SSS. They were randomized during the first post-implant day either to DDDR or WIR pacing mode and were reevaluated after 30 days. Group A comprised 35 patients on DDDR pacing mode and group B 32 patients on WIR pacing mode. Peripheral blood samples were drawn for BNP measurement at the time of randomization and one month later. RESULTS: BNP levels increased significantly in both groups at 30 days (group A: 85.6 +/- 29.5 pg/ml to 107.2 +/- 34.6 pg/ml, group B: 82.7 +/- 27.6 pg/ml to 253.1 +/- 60.2 pg/ml). On day 30, BNP levels in group B were significantly higher than in group A (P < 0.0001). CONCLUSIONS: Pacing from the apex of the right ventricle provokes an increase in the BNP levels regardless of the pacing mode. BNP is probably a very early marker predicting the structural and/or functional heart changes after long-term pacing from the apex of the right ventricle.

Acute myocardial infarction and transient ischemic attack in a patient with lone atrial fibrillation and normal coronary arteries.

We present the case of a 50-year old female with a history of paroxysmal atrial fibrillation and without any antithrombotic therapy, who was admitted to the neurologic department of our hospital with symptoms of cerebral ischemia. Two hours after the release of the neurological syndrome, she experienced an acute ST-segment elevation myocardial infarction (STEMI) of the inferior wall, which was not thrombolysed due to active menstruation. The coronary angiography was performed nine days later and it showed normal coronary arteries. This is the first case report of a TIA and an acute myocardial infarction due to atrial emboli, in a middle aged woman without any coronary lesions. In our opinion it points out the strength and the effectiveness of the internal fibrinolytic mechanisms.