Effects of implantable cardioverter defibrillator implantation and shock application on biochemical markers of myocardial damage.
BACKGROUND
Implantable cardioverter defibrillator (ICD) implantation is a common approach in patients at high risk of sudden cardiac death. To check for normal function, it is necessary to test the ICD. For this purpose, repetitive induction and termination of ventricular fibrillation by direct current shocks is required. This may lead to minor myocardial damage. Cardiac troponin T (cTnT) and I (cTnI) are specific markers for the detection of myocardial injury. Because these proteins usually are undetectable in healthy individuals, they are excellent markers for detecting minimal myocardial damage. The objective of this study was to evaluate the effect of defibrillation of induced ventricular fibrillation on markers of myocardial damage.


METHODS
This study included 14 patients who underwent ICD implantation and intraoperative testing. We measured cTnT, cTnI, creatine kinase MB (CK-MB) mass, CK activity, and myoglobin before and at definite times after intraoperative shock application.


RESULTS
Depending on the effectiveness of shocks and the energy applied, the cardiac-specific markers cTnT and cTnI, as well as CK-MB mass, showed a significant increase compared with the baseline value before testing and peaked for the most part 4 h after shock application. In contrast, the increases in CK activity and myoglobin were predominantly detectable in patients who received additional external shocks.


CONCLUSIONS
ICD implantation and testing leads to a short release of cardiac markers into the circulation. This release seems to be of cytoplasmic origin and depends on the number and effectiveness of the shocks applied.
Institut für Klinische Chemie und Pathobiochemie, and I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
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D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects*; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000032:analysis; D014693:Ventricular Fibrillation / Q000601:surgery / Q000628:therapy*
D015415:Biomarkers; D007527:Isoenzymes; D019210:Troponin I; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form