Journal of Arrhythmia (Dec 2016)

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

  • Daisuke Ishigaki, M.D.,
  • Daisuke Kutsuzawa, M.D.,
  • Takanori Arimoto, M.D.,
  • Tadateru Iwayama, M.D.,
  • Naoaki Hashimoto, M.D.,
  • Yu Kumagai, M.D.,
  • Satoshi Nishiyama, M.D.,
  • Hiroki Takahashi, M.D.,
  • Tetsuro Shishido, M.D.,
  • Takuya Miyamoto, M.D.,
  • Joji Nitobe, M.D.,
  • Akio Fukui, M.D.,
  • Tetsu Watanabe, M.D.,
  • Isao Kubota, M.D.

DOI
https://doi.org/10.1016/j.joa.2016.03.007
Journal volume & issue
Vol. 32, no. 6
pp. 481 – 485

Abstract

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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.

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