Impact of DDD and VVIR Stimulation Modes on Functional Capacity and Quality of Life of Chagasic Patients
Keywords:
Chagas disease, Pacemaker, Quality of lifeAbstract
Introduction: Atrioventricular stimulation provides hemodynamic benefits over the isolated ventricular rate, but this advantage is not completely established in chagasic patients with systolic dysfunction. Objectives: To evaluate the influence of DDD and VVIR stimulation modes on functional capacity, quality of life (QoL) and laboratory abnormalities of a natriuretic peptide in chagasic patients with ventricular dysfunction submitted to pacemaker implantation. Methods: Twenty patients (55% male) with a mean age of 62.7 (± 9.9 years) and a mean ejection fraction of 41.8% (± 2.8) were prospectively studied. Alternately, patients received pacing in the DDD and VVIR modes for a period of three months under each schedule. The minimum percentage of ventricular pacing was 80%. After each period, the patient was submitted to the six-minute walk test (6MWT), QOL assessment by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Assay of QUAlity of life and RELated events (AQUAREL). Laboratory evaluation was performed with the N-terminal fraction of the brain natriuretic peptide (N-terminal pro b-type natriuretic peptide - NT-proBNP). Results: The mean distance walked on the 6MWT in the DDD and VVIR modes were 390.60 (± 52.71) and 396.30 (± 52.71) meters respectively (p = 0.160). Results of lower QOL were found, considering the physical domain of the MLHFQ (p = 0.03) and the domains of effort dyspnea (p = 0.05) and arrhythmia (p <0.001) of the AQUAREL with the VVIR mode. NT-proBNP levels increased significantly with stimulation in VVIR mode (p < 0.001). Conclusion: After three months of stimulation with the VVIR mode, there was worsening of the QoL of the chagasic patients and increase of the levels of NT-proBNP (clinical trial record: ReBEc RBR-53x476).
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References
Rassi AJ, Rassi A, Marin-Neto J. Chagas disease. Lancet. 2010;375(9723):1388-402. https://doi.org/10.1016/S0140-6736(10)60061-X
World Health Organization. Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Weekly Epidemiol Rec. 2015;90(6):33-43.
Sabino EC, Ribeiro AL, Salemi VMC, Di Lorenzo Oliveira C, Antunes AP, Menezes MM, et al. Ten-year incidence of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi seropositive former blood donors. Circulation. 2013;127(10):1105-15. https://doi.org/10.1161/circulationaha.112.123612
Pachon JC, Pereira W, Batista Junior WD, Pachón JPM, Pachón CEI, Vargas RNA, et al. RBM - Registro Brasileiro de Marcapassos, Ressincronizadores e Desfibriladores.
Relampa. 2013;26(1): 39-49.
Rassi A, Rassi Jr A, Faria GHDC. História natural do bloqueio atrioventricular total de etiologia chagásica. Arq Bras Cardiol. 1992;59(Suppl II):191.
Martinelli Filho M, Zimerman LI. Diretrizes brasileiras de dispositivos cardíacos eletrônicos implantáveis (DCEI). Arq Bras Cardiol. 2007;89(6):e210-38.
American Thoracic Association. ATS statement: guidelines for the six-minute walking test. Am J Resp Critical Care Med. 2002;166(1):111-7. https://doi.org/10.1164/ajrccm.166.1.at1102
Carvalho VO, Guimarães GV, Carrara D, Bacal F, Bocchi EA. Validação da versão em português do Minnesota Living with Heart Failure Questionnaire. Arq Bras Cardiol. 2009;93:39-44. https://doi.org/ 10.1590/S0066-782X2009000700008
Beasley TM, Schumacker RE. Multiple regression approach to analyzing contingency tables: post hoc and planned comparison procedures. J Exp Educ. 1995;64(1):79-93.
https://doi.org/10.1080/00220973.1995.9943797
Rector TS, Kubo SH, Cohn JN. Validity of the Minnesota Living with Heart Failure Questionnaire as a measure of therapeutic response to enalapril or placebo. Am J Cardiol.
;71(12):1106-7.
Santos JRC. Marcapassos dupla-câmara com resposta de frequência melhoram a qualidade de vida dos pacientes? Relampa. 2002;15(4):201-5.
Oliveira BG, Abreu MNS, Abreu CDG, Rocha MOC, Ribeiro AL. Health-related quality of life in patients with Chagas disease. Rev Soc Bras Med Trop. 2011;44:150-6. https://doi.
org/10.1590/S0037-86822011005000002
Barros RTD, Carvalho SMRD, Silva MAM, Borges JBC. Avaliação de aspectos da qualidade de vida em pacientes pós-implante de marcapasso cardíaco. Rev Bras Cir Cardiovasc. 2014:37-44. https://doi.org/10.5935/1678-9741.20140009
Lamas GA, Orav EJ, Stambler BS, Ellenbogen KA, Sgarbossa EB, Huang SKS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared
with dual-chamber pacing. NEJM. 1998;338(16):1097-104. https://doi.org/10.1056/NEJM199804163381602
Teno LAC, Costa R, Martinelli Filho M, Castilho FCT, Ruiz I. Mudança do modo VVI para DDD (“upgrade”) na troca eletiva do gerador de pulsos: análise comparativa clínicofuncional. Arq Bras Cardiol. 2007;88(2):128-33. https://doi.org/10.1590/S0066-782X2007000200001
Udo EO, van Hemel NM, Zuithoff NP, Nijboer H, Taks W, Doevendans PA, et al. Long term quality-of-life in patients with bradycardia pacemaker implantation. Inter
J Cardiol. 2013;168(3):2159-63. https://doi.org/10.1016/j.ijcard.2013.01.253
Ouali S, Neffeti E, Ghoul K, Hammas S, Kacem S, Gribaa R, et al. DDD versus VVIR pacing in patients, ages 70 and over, with complete heart block. Pacing Clin Electrophysiol. 2010;33(5):583-9. https://doi.org/10.1111/j.1540-8159.2009.02636.x
Sá LAB, Rassi S, Batista MAL. Efeitos da estimulação ventricular convencional em pacientes com função ventricular normal. Arq Bras Cardiol. 2009;93:167-73. https://doi.org/10.1590/S0066-782X2009000800016
Porapakkham P, Porapakkham P, Zimmet H, Billah B, Krum H. B-type natriuretic peptide-guided heart failure therapy: a meta-analysis. Arch Intern Med. 2010;170(6):507-14. https://doi.org/10.1001/archinternmed.2010.35
Naegeli B, Kurz DJ, Koller D, Straumann E, Furrer M, Maurer D, et al. Single-chamber ventricular pacing increases markers of left ventricular dysfunction compared with dual-chamber pacing. Europace. 2007;9(3):194-9. https://doi.org/10.1093/europace/eul186
Souza SF, Nascimento B, Nunes MCP, da Silva JLP, Carvalho VT, Beaton AZ, et al. Effect of pacemaker site on B-type natriuretic peptide levels, and left ventricular function in a population with high prevalence of Chagas disease. Inter J Cardiol. 2015;190:315-8. https://doi.org/10.1016/j.ijcard.2015.04.127
Nikoo MH, Ghaedian MM, Kafi M, Fakhrpour A, Jorat MV, Pakfetrat M, et al. Effects of right ventricular septal versus apical pacing on plasma natriuretic peptide levels. J Cardiovasc Dis Res. 2011;2(2):104-9. https://doi.org/10.4103%2F0975-3583.83036
