Serum troponin I level after external electrical direct current synchronized cardioversion in patients with normal or reduced ejection fraction: No evidence of myocytes injury

Abstract

SummaryBackground: External electrical cardioversion (EEC) has been suggested as a cause of myocardial damage, but results from several previously published studies are conflicting.Hypothesis: The purpose of the study was to evaluate myocardial electrical injury caused by EEC.Methods: After elective EEC for atrial fibrillation (AF), cardiac troponin I (cTnI) was measured in 193 consecutive patients attending the Cardiology Department of the San Maurizio Hospital of Bolzano for elective EEC of AF over a period of 13 months. External electrical cardioversion was performed by one of the attending cardiologists with a synchronized monophasic defibrillator. Blood sample for cTnI was taken 18-20 h after EEC.Results: Of 193 patients, 183 (95%) were successfully cardioverted. Mean number of shocks was 1.46 and the mean total energy discharged per procedure was 379.4 ± 229.2 J. Cardiac troponin remained under the limit of confidence for all patients with a mean value of 0.017 ± 0.021 mcrg/l. No correlation between total energy delivered and cTnI was found. In the subgroup of patients with low ejection fraction, none had elevated cTnI, and no difference in cTnI values between these and patients with an ejection fraction > 40% was found.

Troponin Levels after Cardiac Electrophysiology Procedures: Review of the Literature

“…Between 1996 and 2006, 13 studies (n = 690) looked at the effect of monophasic external cardioversion on cTn level (Table I). 64–75,78 Four studies used cTnI, seven used cTnT, and two used both (cTnI, cTnT). The majority were cardioversion of A.Fib/Flut.…”

“…Monophasic external cardioversion caused no or only minimally insignificant elevation in cTn level, 64–75 even for induced VT/VF 78 . Overall, only 1.6% of patients who underwent monophasic external cardioversion had increase in cTn level, and it was only in the range of minimal myocardial energy (>0.1 ng/mL and <1.5 ng/mL) with a range of 0.1–0.9 ng/mL for cTnI 73–75 .…”

Analysis of haematological and biochemical blood parameters after electrical cardioversion of atrial fibrillation in dogs

“…Tissue injury has been intensively studied; however, only with regard to the cardiac myocytes. Several studies on cardiac troponin levels indicated no or only minimal, clinically insignificant cardiac damage (2,7). A small single study reported a transient creatine kinase increase, pointing to skeletal muscle involvement, while another study confirmed a generalised inflammatory response, which could possibly exacerbate the thrombotic risk of EC (4,6).…”

“…There is evidence that direct current flow through the patient's body can cause minimal cell injury, which has been intensively studied in the heart muscle. Most reports indicated no cardiac damage or no clinically significant damage as assessed by means of troponin concentrations (2,7). Only a single report exists regarding the possible injury of other components of the chest such as thoracic muscles (6).…”

Myocardial Injury after Electric Accident: Dynamic Change of Cardiac Biomarkers Was the Important Key for Diagnosis of This Serious Complication

“…Cardioversion can lead to mild cTnI rise as measured with a high-sensitivity assay [2]. There was no evidence of myocytes injury, no increase of troponin I after external electrical direct current synchronized cardioversion in patients with normal or reduced ejection fraction [3]. It was rare for electrical injury case with serious myocardial damage and death.…”