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Mechanistic implication of decreased plasma atrial natriuretic peptide level for transient rise in the atrial capture threshold early after ICD or CRT-D implantation

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Abstract

Purpose

Despite the use of steroid-eluting leads, a transient but not persistent rise in the atrial/ventricular capture threshold (TRACT/TRVCT) can occur early after pacemaker implantation in patients with sick sinus syndrome. This study aimed to assess the prevalence, predictors, and mechanisms of TRACT/TRVCT in patients with heart failure undergoing implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) implantation.

Method

One hundred twenty consecutive patients underwent ICD (N = 70) or CRT (N = 50) implantation. Capture threshold was measured at implantation, 7-day, 1-month, and 6-month post-implantation. TRACT/TRVCT was defined as a threshold rise at 7 days by more than twice the height of the threshold at implantation, with full recovery during follow-up. Atrial and brain natriuretic peptide (ANP and BNP) levels were measured before implantation.

Results

TRACT and TRVCT were observed in 13 (11%) and 10 (8%) patients, respectively. Patients with TRACT had lower ANP level (median 72 [42–105] vs. 99 [49–198] pg/mL, P = 0.06), lower ANP/BNP ratio (0.29 [0.20–0.36] vs. 0.50 [0.33–0.70], P < 0.01), lower atrial sensing amplitude (2.0 ± 0.8 vs. 2.7 ± 1.3 mV, P = 0.02), and lower left ventricular ejection fraction (32 ± 12 vs. 40 ± 14%, P = 0.04) than those without TRACT. TRACT recovered within 1 month, whereas TRVCT recovered within 6 months. In multivariable analysis, ANP/BNP ratio was the only independent predictor of TRACT (OR, 0.018; 95% CI, 0.001–0.734; P = 0.034).

Conclusions

Atrial degenerative change characterized by lower ANP/BNP ratio was associated with the occurrence of TRACT in patients with heart failure. TRVCT could also occur, but it required a longer recovery time than TRACT.

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Abbreviations

ANP:

Atrial natriuretic peptide

BNP:

Brain (B-type) natriuretic peptide

CRT-D (P):

Cardiac resynchronization therapy defibrillator (pacemaker)

ICD:

Implantable cardioverter defibrillator

LVEF:

Left ventricular ejection fraction

SSS:

Sick sinus syndrome

TRACT:

Transient rise in the atrial capture threshold

TRVCT:

Transient rise in the ventricular capture threshold

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Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan

    Kojiro Ogawa, Kentaro Yoshida, Akira Kimata, Masaki Ieda, Kazutaka Aonuma & Akihiko Nogami

  2. Division of Cardiovascular Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan

    Kojiro Ogawa, Hidetaka Nishina & Yuichi Noguchi

  3. Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan

    Kentaro Yoshida, Yoshiko Uehara, Mari Ebine & Noriyuki Takeyasu

Authors
  1. Kojiro Ogawa
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  2. Kentaro Yoshida
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  3. Yoshiko Uehara
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  4. Mari Ebine
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  5. Akira Kimata
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  6. Hidetaka Nishina
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  7. Noriyuki Takeyasu
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  8. Yuichi Noguchi
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  9. Masaki Ieda
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  10. Kazutaka Aonuma
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  11. Akihiko Nogami
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Corresponding author

Correspondence to Kentaro Yoshida.

Ethics declarations

The study protocol was approved by the hospital’s institutional review board. The study complied with the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Ogawa, K., Yoshida, K., Uehara, Y. et al. Mechanistic implication of decreased plasma atrial natriuretic peptide level for transient rise in the atrial capture threshold early after ICD or CRT-D implantation. J Interv Card Electrophysiol 53, 131–140 (2018). https://doi.org/10.1007/s10840-018-0409-0

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  • DOI: https://doi.org/10.1007/s10840-018-0409-0

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