Effects of implantable cardioverter defibrillator implantation and shock application on serum endothelin-1 and big-endothelin levels.
The incidence of ventricular tachyarrhythmias in the early post-operative period following implantable cardioverter-defibrillator (ICD) implantation is relatively high compared with that in control periods. Since endothelin-1 (ET-1) has been proven to be an endogenous arrhythmogenic substance, we investigated the changes in serum ET-1 and big-ET levels in patients undergoing ICD implantation. Serum concentrations of ET-1 and big-ET were measured in 14 patients with various heart diseases before the operation, as well as 1 min and 1 h after the last shock therapy. Big-ET levels and the sum of ET-1 and big-ET levels were unchanged immediately after the operation, but had increased significantly by 1 h after implantation (before, 1.57+/-0.61 pmol/l; 1 min, 1.86+/-0.87 pmol/l; 1 h, 4.29+/-1.65 pmol/l for big-ET; before, 3.44+/-1.07 pmol/l; 1 min, 3.79+/-1.29 pmol/l; 1 h, 6.36+/-2.03 pmol/l for big-ET+ET-1). There was a significant correlation between left ventricular ejection fraction and big-ET level measured 1 h after the last shock delivery (r=-0.542, P<0.05). We conclude that the increased big-ET level observed 1 h after the last induction and shock therapy of ventricular fibrillation might have a pathophysiological role in the increased incidence of post-operative spontaneous ventricular arrhythmias.
Department of Cardiovascular Surgery, Semmelweis University, Városmajor u. 68. H-1122 Budapest, Hungary. Szucsand@kkt.sote.hu
Andrea
A
Szücs
Katalin
K
Keltai
Endre
E
Zima
Hajnalka
H
Vágó
Pál
P
Soós
Attila
A
Róka
Zoltán
Z
Szabolcs
László
L
Gellér
Béla
B
Merkely
D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D019332:Endothelin-1 / Q000097:blood*; D016232:Endothelins / Q000097:blood*; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D017180:Tachycardia, Ventricular / Q000097:blood / Q000209:etiology*; D013997:Time Factors
D019332:Endothelin-1; D016232:Endothelins; D011498:Protein Precursors