R. Pecini et al. / World Journal of Cardiovascular Diseases 3 (2013) 471-475
474
nary sinus. This amount of blood empties then in the left
ventricle. Thus, the majority of this amount of blood cir-
culates directly into the periphery, and only a minor
amount into the coronary artery system. One other ex-
planation could be our sequential method of blood sam-
pling, starting in the coronary sinus. In any case, there is
little doubt that the increased levels of ANP are directly
related to the tachycardia episode.
Even in patients with lone atrial fibrillation, baseline
BNP levels are increased [8], and these levels are even
higher in patients with persistent and permanent atrial
fibrillation [9,17,18]. On the other hand, atrial fibrillation
is an arrhythmia, which is associated with considerable
morbidity and mortality [19]. On the contrary, AVNRT is
not associated with increased mortality and the treatment
is usually guided by the burden of symptoms. Further-
more, recent data have shown that the BNP levels in pa-
tients with atrial fibrillation are especially increased in
the coronary sinus [20]. We did not detect any increase of
BNP in blood samples from coronary sinus. This is an-
other fundamental difference between these two arrhy-
thmias. Whether this difference in BNP levels can ex-
plain the difference in the morbidity between atrial fib-
rillation and AVNRT is unsure. However, we know that
in other cardiac pathologies, morbidity and mortality risk
is closely related to the levels of BNP [4-7].
5. LIMITATIONS
Our number of patients was limited. For this reason, we
may have overlooked changes in BNP levels due to in-
adequate power. It is also possible that if we had repeated
the measurements of BNP later on we might have been
able to detect a change in the BNP levels.
6. CONCLUSION
Peripheral plasma levels of ANP but not BNP rose
acutely in response to tachycardia in patients with AVNRT.
This finding is in contrast to patients with chronic atrial
fibrillation indicating the different pathophysiology in-
volved in the two conditions.
7. ACKNOWLEDGMENTS
Special thanks to Jens Peter Goetze MD, for his valuable comments on
the manuscript.
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