Neuronal Injury After Repeated Brief Cardiac Arrests During Internal Cardioverter Defibrillator Implantation Is Associated With Deterioration of Cognitive Function

Abstract

To determine the degree of neurocognitive dysfunction after placement of internal cardioverter defibrillators (ICD) and its relationship to the extent of neuronal injury, we studied 42 patients undergoing ICD (n = 21) or pacemaker (PM) insertion (control patients, n = 21). The Mini Mental State Examination, the Trailmaking A test and the forward and backward Digit Span tests were used and P300 latencies were determined preoperatively and postoperatively. Serum neuron-specific enolase (NSE) was determined before and at the end of, as well as 2, 6, and 24 h after surgery. Preoperatively, PM patients scored worse in the Digit Span backward and the Trailmaking tests and showed prolonged P300 latencies. Postoperatively, the Digit Span backward scores declined and NSE levels increased only in the ICD group (P < or = 0.05). The difference between preoperative and postoperative Digit Span backward scores correlated with the increase in serum NSE levels (r2 = 0.3, P < or = 0.05). Moreover, P300 latencies increased in 13 of 17 ICD patients, but decreased in 7 of 10 PM patients (P < or = 0.05). PM patients even improved in the Trailmaking test (P < or = 0.05). Neuronal injury from even brief periods of global brain ischemia seems to be associated with deteriorating neurocognitive function.

<b>Defibrillation Testing and Early Neurologic Outcome</b>

“…KARAOGUZ, ET AL ˆ S imilar results have been reported by Weigl, et al 15) They studied 42 patients undergoing ICD (n = 21) or PM insertion (n = 21) and serum NSE levels were determined at the same time period mentioned in the previous study. Serum NSE levels increased over time in the ICD group.…”

“…14,15) Dworshcak, et al determined the NSE serum level preoperatively, immediately postoperatively, and 2 hours postoperatively in 45 patients undergoing ICD implantation. 14) The serum NSE level of all the ICD patients increased significantly from baseline to 2 hours after surgery.…”

“…[11][12][13] In recently published studies, significant increases in some biochemical markers of ischemic cerebral injury, such as neuron specific enolase (NSE), have been reported after implantation of ICD. 14,15) NSE, a dimeric isoenzyme of the glycolytic enzyme enolase, is mainly found in the cytoplasm of neurons and cells of neuroendocrine origin and has a high predictive value for neurocognitive deficits and neurological outcome after cardiac arrest, stroke, and cardiac surgery. [16][17][18][19] However, the literature presents limited data on the relationship between the increase in NSE and neurological outcome after VF during ICD procedures.…”

Cerebral desaturation during cardiac arrest: Its relation to arrest duration and left ventricular pump function*

“…The concomitant episodes of brief global cerebral ischemia have been associated with cognitive dysfunction (5,6) and elevated serum concentrations of biochemical markers of cerebral injury (7). Immediately after induction of VF, a decrease in invasively determined jugular venous oxygen saturation was noticed in patients, implying that an imbalance between cerebral oxygen supply and oxygen consumption occurs early.…”

Implantation von Kardioverter-Defibrillatoren

“…Postoperativ neu aufgetretene neurologische Auffälligkeiten wurden jedoch nicht registriert. Demgegenüber konnte 2006 in einer Folgeuntersuchung eine positive Korrelation zwischen erhöhten Serum-NSE-Werten und kognitiven Dysfunktionen gezeigt werden [92].…”