The association between defibrillation shock energy and acute cardiac damage in patients with implantable cardioverter defibrillators

• Published in: Journal of arrhythmia Vol. 32; no. 6; pp. 481 - 485
• Main Authors: Ishigaki, Daisuke, M.D, Kutsuzawa, Daisuke, M.D, Arimoto, Takanori, M.D, Iwayama, Tadateru, M.D, Hashimoto, Naoaki, M.D, Kumagai, Yu, M.D, Nishiyama, Satoshi, M.D, Takahashi, Hiroki, M.D, Shishido, Tetsuro, M.D, Miyamoto, Takuya, M.D, Nitobe, Joji, M.D, Fukui, Akio, M.D, Watanabe, Tetsu, M.D, Kubota, Isao, M.D
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.12.2016; Elsevier; Wiley
• Subjects: Analysis; Cardiac arrhythmia; Cardiac patients; Cardiovascular; Cardiovascular disease; Care and treatment; Defibrillation test; Defibrillators; Diabetes; Disease prevention; Ejection fraction; Electric countershock; Enzymes; Fatty acids; Heart; Heart-type fatty acid binding protein; Hypertension; Implantable cardioverter defibrillator; Implants, Artificial; Ischemia; Metabolic disorders; Myocardial injury; Original; Patients; Polypeptides; Prosthesis; Protein binding; Proteins; Troponin T; United States > US; Defibrillation test; Heart-type fatty acid binding protein; Implantable cardioverter defibrillator; Myocardial injury; Troponin T
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1016/j.joa.2016.03.007

Abstract Background The aim of this study was to establish a minimally invasive defibrillation testing (DT) protocol for patients with implantable cardioverter defibrillators (ICDs). Methods Two different energy DTs were performed, immediately after (15 J-DT) and 7 days after (≤10 J-DT) device implantation, in 20 consecutive ICD implantation patients. Cardiac-troponin T (c-TNT) and heart-type fatty acid binding protein (H-FABP) levels were measured before implantation, 2 h after implantation, and 1 day after each DT. For an additional 122 patients with ICD, we retrospectively analyzed 203 DTs immediately and 7 days after device implantation. Results Serum c-TNT levels were significantly elevated 2 h after 15 J-DT [0.008 (0.004–0.019) vs. 0.053 (0.037–0.068) ng/mL, p <0.001], but not ≤10 J-DT [0.007 (0.004–0.018) ng/mL]. Similarly, serum H-FABP levels were significantly elevated 2 h after 15 J-DT (2.9±1.5 vs. 6.4±3.4 ng/mL, p <0.001), but not ≤10 J-DT (2.7±1.5 ng/mL). The changes in c-TNT and H-FABP levels between baseline and 2 h after DT were significantly greater for 15 J-DT compared with ≤10 J-DT [c-TnT: 0.039 (0.029–0.060) vs. 0 (0–0.003) ng/mL, p <0.001; H-FABP: 3.6±2.8 vs. −0.16±1.1 ng/mL, p <0.001]. The success rates of the initial shocks delivered for ventricular fibrillation were no different between ≤10 J-DT (85% [78/92]) and ≥15 J-DT (92% [103/111]). Conclusions Elevated levels of myocardial damage markers such as c-TNT and H-FABP were not found after ≤10 J-DT. In addition, an acceptable success rate was confirmed in ≤10 J-DT.