The association between defibrillation shock energy and acute cardiac damage in patients with implantable cardioverter defibrillators

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• 作者：Daisuke Ishigaki ; M.D.¹ ; Daisuke Kutsuzawa ; M.D.¹ ; Takanori Arimoto ; M.D. ; ^{t-arimoto@med.id.yamagata-u.ac.jp} ; Tadateru Iwayama ; M.D. ; Naoaki Hashimoto ; M.D. ; Yu Kumagai ; M.D. ; Satoshi Nishiyama ; M.D. ; Hiroki Takahashi ; M.D. ; Tetsuro Shishido ; M.D. ; Takuya Miyamoto ; M.D. ; Joji Nitobe ; M.D. ; Akio Fukui ; M.D. ; Tetsu Watanabe ; M.D. ; Isao Kubota ; M.D.
• 关键词：Implantable cardioverter defibrillator ; Defibrillation test ; Myocardial injury ; Heart-type fatty acid binding protein ; Troponin T
• 刊名：Journal of Arrhythmia
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：32
• 期：6
• 页码：481-485
• 全文大小：755 K
• 卷排序：32

文摘

The aim of this study was to establish a minimally invasive defibrillation testing (DT) protocol for patients with implantable cardioverter defibrillators (ICDs).MethodsTwo different energy DTs were performed, immediately after (15 J-DT) and 7 days after (≤10 J-DT) device implantation, in 20 consecutive ICD implantation patients. Cardiac-troponin T (c-TNT) and heart-type fatty acid binding protein (H-FABP) levels were measured before implantation, 2 h after implantation, and 1 day after each DT. For an additional 122 patients with ICD, we retrospectively analyzed 203 DTs immediately and 7 days after device implantation.ResultsSerum c-TNT levels were significantly elevated 2 h after 15 J-DT [0.008 (0.004–0.019) vs. 0.053 (0.037–0.068) ng/mL, p<0.001], but not ≤10 J-DT [0.007 (0.004–0.018) ng/mL]. Similarly, serum H-FABP levels were significantly elevated 2 h after 15 J-DT (2.9±1.5 vs. 6.4±3.4 ng/mL, p<0.001), but not ≤10 J-DT (2.7±1.5 ng/mL). The changes in c-TNT and H-FABP levels between baseline and 2 h after DT were significantly greater for 15 J-DT compared with ≤10 J-DT [c-TnT: 0.039 (0.029–0.060) vs. 0 (0–0.003) ng/mL, p<0.001; H-FABP: 3.6±2.8 vs. −0.16±1.1 ng/mL, p<0.001]. The success rates of the initial shocks delivered for ventricular fibrillation were no different between ≤10 J-DT (85% [78/92]) and ≥15 J-DT (92% [103/111]).ConclusionsElevated levels of myocardial damage markers such as c-TNT and H-FABP were not found after ≤10 J-DT. In addition, an acceptable success rate was confirmed in ≤10 J-DT.