title: Effect of transvenous cardiac resynchronization therapy device implantation on cardiac troponin I release.
abstract: BACKGROUND
  Pacemaker and implantable cardioverter defibrillator (ICD) implantation increases cardiac troponin I (cTnI) levels which indicates myocardial injury. During implantation of a cardiac resynchronization therapy (CRT) device, balloon inflation for coronary sinus (CS) venogram, cannulation of CS side branch, and electrode advancement may interfere with CS drainage and, hence, may decrease the washout of toxic metabolites from the heart. Thus, CRT implantation may further increase cTnI levels. In this study, we investigated the effects of CRT implantation on cTnI release.
  
  
  METHODS
  We included 10 patients (mean age = 57 +/- 15 years) in whom a successful transvenous CRT system was implanted (CRT group). Twenty patients (mean age = 65 +/- 10 years) who underwent a transvenous pacemaker or ICD implantation were included as the control group. Blood samples for cTnI were drawn at baseline and at six, 12, 18, and 24 hours thereafter.
  
  
  RESULTS
  Baseline median cTnI levels were similar in CRT and control groups (0.03 ng/mL vs 0.02 ng/mL, respectively; P = 0.1). Postoperative cTnI levels during 24 hours were significantly higher in the CRT group (P < 0.05) by two-way repeated measures of analysis of variance. Post hoc analysis revealed that cTnI levels were higher at the 6th, 12th, 18th, and 24th hours compared to baseline levels (P < 0.001, P < 0.001, P < 0.01, and P < 0.01, respectively). There was a significant difference in the area under the curves (AUCs) of cTnI measurements (1.79 hr.ng/mL in the CRT group and 0.78 hr.ng/mL in the control group, P < 0.05).
  
  
  CONCLUSIONS
  Postoperative cTnI levels were higher after CRT implantation than simple pacemaker/ICD implantation. This may be due to CS manipulation during CRT implantation.
authors.affiliation: Ankara University School of Medicine, Department of Cardiology, Ankara, Turkey. alitimaltin@yahoo.com
authors.forename: Timucin
authors.initials: T
authors.lastname: Altin
authors.forename: Omer
authors.initials: O
authors.lastname: Akyurek
authors.forename: Kutay
authors.initials: K
authors.lastname: Vurgun
authors.forename: Osman
authors.initials: O
authors.lastname: Beton
authors.forename: Tamer
authors.initials: T
authors.lastname: Sayin
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kilickap
authors.forename: Remzi
authors.initials: R
authors.lastname: Karaoguz
authors.forename: Muharrem
authors.initials: M
authors.lastname: Guldal
authors.forename: Cetin
authors.initials: C
authors.lastname: Erol
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000097:blood* / Q000150:complications / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods*; D019210:Troponin I / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000150:complications / Q000517:prevention & control
chemical_list: D019210:Troponin I