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Titolo:
EFFECTS OF ATRIOVENTRICULAR ASYNCHRONY ON PLATELET ACTIVATION - IMPLICATION OF THROMBOEMBOLISM IN PACED PATIENTS
Autore:
LAU CP; TSE HF; CHENG G;
Indirizzi:
UNIV HONG KONG,QUEEN MARY HOSP,DEPT MED,DIV CARDIOL HONG KONG HONG KONG UNIV HONG KONG,QUEEN MARY HOSP,DEPT PATHOL HONG KONG HONG KONG
Titolo Testata:
HEART
fascicolo: 4, volume: 78, anno: 1997,
pagine: 358 - 363
SICI:
1355-6037(1997)78:4<358:EOAAOP>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
SICK-SINUS SYNDROME; PLASMA BETA-THROMBOGLOBULIN; ATRIAL-FIBRILLATION; CEREBRAL-ISCHEMIA; FACTOR-4; DISEASE; INVIVO; PACEMAKER; MARKERS; STROKE;
Keywords:
PACING; THROMBOEMBOLISM; PLATELET ACTIVATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
32
Recensione:
Indirizzi per estratti:
Citazione:
C.P. Lau et al., "EFFECTS OF ATRIOVENTRICULAR ASYNCHRONY ON PLATELET ACTIVATION - IMPLICATION OF THROMBOEMBOLISM IN PACED PATIENTS", HEART, 78(4), 1997, pp. 358-363

Abstract

Objective-To investigate the platelet activation in different modes of pacing in patients implanted with dual chamber rate adaptive pacemaker (DDDR) for bradyarrhythmias, and to explore the possible underlyingmechanism of the higher thromboembolic incidence in single chamber ventricular rate adaptive (VVIR) pacing. Design-Platelet activation was determined in chronically paced patients during three different pacingmodes (VVIR, DDD, and DDDR) in a randomised crossover fashion. Setting-Pacemaker clinic at a university teaching hospital. Patients-15 patients with complete heart block, mean (SD) age 63 (10) years, and 12 patients with sick sinus syndrome, mean age 68 (9) years, implanted withDDDR pacemakers. Main outcome measures-Platelet activation was assessed by measuring the plasma concentrations of platelet factor 4 (PF4) and beta thromboglobulin using an enzyme linked immunosorbent assay (ELISA). Mean log plasma PF4 and beta thromboglobulin values were compared in paced patients during different pacing modes and with control. Results-Compared with controls, patients paced in DDDR, DDD, and VVIR modes had higher mean log plasma concentrations of PF4 (0.90 (0.32), 0.92 (0.29), and 1.12 (0.33) v 0.61 (0.29) log IU/ml, all p < 0.05, respectively) and beta thromboglobulin (1.55 (0.20), 1.59 (0.16), and 1.71 (0.18) v 1.40 (0.12) log IU/ml, all p < 0.05, respectively). In paced patients, VVIR pacing was associated with higher plasma concentrationsof PF4 and beta thromboglobulin than either DDDR or DDD pacing (all p< 0.05). There was no significant difference in plasma PF4 and beta thromboglobulin between patients with complete heart block and sick sinus syndrome in the corresponding pacing mode. Holter monitoring showedno difference in mean pacing rate and occurrence of cardiac arrhythmias to account for the increased platelet activation during VVIR pacing. There was no relation between the percentage of ventricular pacing on Holter during DDDR, DDD, and VVIR modes and the log mean plasma concentrations of PF4 (r = 0.002, 0.001, and 0.001, respectively, all p > 0.05) and beta thromboglobulin (r = 0.007, 0.01, and 0.001, respectively, all p > 0.05). Conclusions-Single chamber ventricular pacing was associated with enhanced spontaneous systemic platelet activation compared with physiological dual chamber pacing. This was related to the loss of atrioventricular synchrony rather than to the underlying cause of bradycardia, lack of rate response, or coexisting arrhythmia. This abnormality may be associated with increased thromboembolism and was correctible by an appropriate pacing mode prescription and possibly antiplatelet treatment.

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Documento generato il 04/07/20 alle ore 17:56:26