BNP/NT‐ProBNP and Cardiac Pacing: A Review

Abstract

Natriuretic peptide (NP) levels (B-type natriuretic peptide [BNP] and N-terminal proBNP) are now widely used in clinical practice and cardiovascular research all over the world and have been incorporated into many cardiovascular guidelines for heart failure (HF). The roles of NP levels are evolving rapidly not only in diagnosis, therapy monitoring, and risk stratification of HF, but also in differential diagnosis of acute dyspnea, predicting death and rehospitalization in HF patients. NP assays have been applied in permanent cardiac pacing in recent years, whereas it is still not well known how NP levels change and whether NP levels can predict HF in permanent cardiac pacing. Therefore, this article reviews the role of NP levels in permanent cardiac pacing, mainly including NP changes in different cardiac pacing modes and cardiac resynchronization therapy.

Are Plasma Natriuretic Peptide Levels Influenced by Automatic Pacemaker Algorithms for Ventricular Pacing Minimization?

“…As healthier hearts can better compensate for wrong pacing sites and sequences, suboptimal pacing modalities exert more influence on natriuretic peptide levels in patients with left ventricular dysfunction. The largest difference in natriuretic peptide levels has been reported in patients with left ventricular dysfunction, when comparing cardiac resynchronization therapy and dual‐chamber pacing from the right ventricle or no pacing . Preservation of AV synchrony by atrial‐based or dual‐chamber pacing in general pacemaker population, versus ventricular‐only pacing, had the second strongest effect on peptide levels .…”

“…The largest difference in natriuretic peptide levels has been reported in patients with left ventricular dysfunction, when comparing cardiac resynchronization therapy and dual-chamber pacing from the right ventricle or no pacing. 3,[28][29][30][31] Preservation of AV synchrony by atrial-based or dual-chamber pacing in general pacemaker population, versus ventricular-only pacing, had the second strongest effect on peptide levels. [3][4][5][6][7]9,13 As discussed above, VP% minimization had smaller effects on natriuretic peptides, 12,13 whereas pacing site variation within the right ventricle had no effect.…”

“…Plasma concentrations of either BNP or its inactive amino‐terminal fragment, NT‐proBNP, are used as clinical markers of left ventricular dysfunction . In patients treated with cardiac pacemakers, BNP or NT‐proBNP can reflect hemodynamic utility of different pacing modes . Physiological pacing preserving atrioventricular (AV) synchrony reduces ventricular wall stress/stretching and, thus, plasma BNP and NT‐proBNP concentrations compared with less physiological pacing …”

“…1,2 In patients treated with cardiac pacemakers, BNP or NT-proBNP can reflect hemodynamic utility of different pacing modes. 3 Physiological pacing preserving atrioventricular (AV) synchrony reduces ventricular wall stress/stretching and, thus, plasma BNP and NT-proBNP concentrations compared with less physiological pacing. [3][4][5][6][7] As pacing from the right ventricular apex impairs left ventricular torsion and synchrony, a higher percentage of ventricular paced events (VP%) in dual-chamber pacemakers might lead to higher BNP and NT-proBNP concentrations.…”

“…3 Physiological pacing preserving atrioventricular (AV) synchrony reduces ventricular wall stress/stretching and, thus, plasma BNP and NT-proBNP concentrations compared with less physiological pacing. [3][4][5][6][7] As pacing from the right ventricular apex impairs left ventricular torsion and synchrony, a higher percentage of ventricular paced events (VP%) in dual-chamber pacemakers might lead to higher BNP and NT-proBNP concentrations. Some investigators demonstrated this expected relationship, [8][9][10] but others failed to confirm it, 11 or observed it only in subsets of patients with either organic heart disease or hemodynamic abnormalities at baseline who were particularly susceptible to the negative effects of pacinginduced ventricular desynchronization.…”