Effect of transvenous cardiac resynchronization therapy device implantation on cardiac troponin I release.
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.
Altin
Timucin
T
Ankara University School of Medicine, Department of Cardiology, Ankara, Turkey. alitimaltin@yahoo.com
Akyurek
Omer
O
Vurgun
Kutay
K
Beton
Osman
O
Sayin
Tamer
T
Kilickap
Mustafa
M
Karaoguz
Remzi
R
Guldal
Muharrem
M
Erol
Cetin
C
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
D019210:Troponin I