Evidence for Acute Myocardial and Skeletal Muscle Injury after Serial Transthoracic Shocks in Healthy Swine.
BACKGROUND
Previous serological studies have shown controversial results whether defibrillation or cardioversion can cause myocardial injury. Cardiovascular Magnetic Resonance (CMR) can be used to detect myocardial edema, hyperemia and capillary leak as features of acute myocardial injury. The aim of this study was to assess for myocardial and skeletal muscle injury in swine following transthoracic shocks.


METHODS
Seventeen anaesthetized swine were examined, with 11 undergoing five synchronized transthoracic shocks (200J). Myocardial and skeletal muscle injury were assessed at baseline and up to 5h post-shock employing T1 mapping, T2 mapping, early and late gadolinium enhancement. Serologic markers (cFABP, TnI, CK, and CK-MB) and myocardial tissue were assessed by standard histology methods.


RESULTS
In myocardial regions within the shock path, T1 and T2 were significantly increased compared to remote myocardium in the same animals. The early gadolinium enhancement ratio between the left-ventricular myocardium and the right pectoral muscle was also increased compared to control animals. After the shocks cFABP and CK were significantly elevated. After shock application, the regions identified as abnormal by CMR showed significantly increased interstitial and myocardial cell areas in histological analysis. This increased cell area suggests significant cellular and interstitial edema.


CONCLUSIONS
Our pilot study data indicate that serial defibrillator shocks lead to acute skeletal muscle and myocardial injury. CMR is a useful tool to detect and localize myocardial and skeletal muscle injury early after transthoracic shocks in vivo. In the future the technique could potentially be used as an additional tool for quality control such as verifying insufficient local shock application in non-responders after cardioversion or to develop safer shock forms.
Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC, Canada.|University Hospital Bern, Department Anaesthesiology and Pain Therapy, Inselspital, University of Bern, Bern, Switzerland.|University Hospital Bern, Institute for Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.
Dominik P
http://orcid.org/0000-0003-4127-4086
DP
Guensch
Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC, Canada.
Janelle
J
Yu
Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC, Canada.
Gobinath
G
Nadeshalingam
Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC, Canada.|University Hospital Bern, Department Anaesthesiology and Pain Therapy, Inselspital, University of Bern, Bern, Switzerland.
Kady
K
Fischer
Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
Jane
J
Shearer
Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC, Canada.|Department of Medicine, McGill University, Montreal, QC, Canada.|Department of Radiology, McGill University, Montreal, QC, Canada.
Matthias G
MG
Friedrich
D000818:Animals; D004554:Electric Countershock / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006439:Hemodynamics; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D010865:Pilot Projects; D013552:Swine