非生理学的心臓ペーシングによる循環血中血小板の活性化に関する研究

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  • ヒセイリガクテキ シンゾウ ペーシング ニ ヨル ジュンカン ケッチュウ ケッショウバン ノ カッセイカ ニ カンスル ケンキュウ
  • Loss of Atrioventricular Synchrony Causes Higher P-Selectin Expression on Circulating Platelets in Patients with a Pacemaker

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Background: Non-physiological pacing has been reported to frequently induce thromboembolism. However, the mechanism of this relationship, particularly regarding the role of platelets, has not yet been elucidated. Objective: To investigate the effects of different pacing modes on platelet activation. Subjects and methods: Subjects were 30 consecutive patients using pacemakers for atrioventricular block without complication by atrial fibrillation. Patients underwent physiological pacing (DDD or VDD; n=16) or non-physiological pacing (VVI; n=14). Blood coagulation tests (platelet factor 4; PF4, (3-thromboglobulin; β-TG, thrombin-antithrombin III complex; TAT, D-dimer) were determined. P-selectin and GPIIb/IIIa expression on platelet surfaces was measured by flow cytometry. Left atrial dimension (LAD) was also measured on echocardiography. Results: LAD was significantly larger (p=0.009) for non-physiological pacing (41.4 ± 7.28mm) than physiological pacing (29.3 ± 2.73mm). P-selectin expression on platelet surfaces was significantly higher p=0.028 for non-physiological pacing (10.79 ± 2.22) than physiological pacing (9.35 ± 1.04). GPIIb/IIIa expression also significantly increased in the nonphysiological pacing group compared to the physiological pacing group, no significant intergroup differences were observed for PF4, β-TG, TAT, or D-dimer. Conclusion: Chronic loss of atrioventricular synchrony induced by non-physiological pacing resulted in a higher P-selectin and GPIIb/IIIa expression on the circulating platelets and an enlarged LAD. These results may be associated with increased thromboembolism.

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