The Ischemia‐Modified Albumin in Relation to Pacemaker and Defibrillator Implantation

Sbarouni, Eftihia; Γεωργιάδου, Παναγιώτα; Panagiotakos, Demosthenes B.; Livanis, Efthimios; Theodorakis, George; Kremastinos, Dimitrios Th.

doi:10.1111/j.1540-8159.2007.00929.x

Cited by 11 publications

(12 citation statements)

References 23 publications

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“…Results from recent in vitro work from our group support this hypothesis and suggest that the generation of reactive oxygen species can at least transiently modify the N‐terminal region of albumin to yield increased levels of IMA 8 . This mechanism may offer an alternative explanation to the interesting findings by Sbarouni et al 1 in patients undergoing pacemaker—defibrillator implantation.…”

supporting

confidence: 63%

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The Ischemia‐Modified Albumin in Relation to Pacemaker and Defibrillator Implantation: The Mechanism of IMA Formation and the Role of Reactive Oxygen Speciespt

Roy

Kaski

2008

Pacing Clinical Electrophis

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supporting

confidence: 63%

“…We read with interest the paper by Sbarouni et al 1 which showed that ischemia‐modified albumin (IMA) levels increase after permanent pacemaker—defibrillator implantation. IMA levels were higher at 6 and 48 hours after pacemaker implantation, compared to baseline.…”

mentioning

confidence: 99%

The Ischemia‐Modified Albumin in Relation to Pacemaker and Defibrillator Implantation: The Mechanism of IMA Formation and the Role of Reactive Oxygen Speciespt

Roy

Kaski

2008

Pacing Clinical Electrophis

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“…"Catecholamine overload" (ref. [27][28][29] or direct mechanical damage [30][31][32][33][34][35][36][37][38][39] during skiascopy of the heart (during pacemaker implantation) can be a marker of procedure complexity and may positively correlate with troponin levels 31 . Left ventricular failure 40 , right ventricular failure [41][42][43] , or the disparity between physiological degradation of the myocardium and insufficient elimination of its fragments (renal insufficiency) (ref.…”

Section: Methodsmentioning

confidence: 99%

“…A similar rate for the onset of troponin I elevation was described by Altin 32 after monitoring 30 patients subjected to implantations of different types of pacemakers. In a study by Sbarouni 33 , the possibility of myocardial injury during the introduction of passive electrodes was demonstrated. This work evaluated a group of 64 patients and found that after primo-implantation of various devices, both troponin I levels and ischemia-modified albumin (IMA) levels were elevated.…”

mentioning

confidence: 99%

Factors underlying elevated troponin I levels following pacemaker primo-implantation

Hnátek¹,

Táborský²,

Malý³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Cardiac troponins are routinely used as markers of myocardial damage. Originally, they were only intended for use in diagnosing acute coronary syndromes; however, we now know that raised serum troponin levels are not always caused by ischemia. There are many other clinical conditions that cause damage to cardiomyocytes, leading to raised levels of troponin. However, the specificity of cardiac troponins towards the myocardium is absolute. Our work focuses on mechanical damage to the myocardium and on monitoring the factors that raise the levels of cardiospecific markers after primo-implantation of a pacemaker with an actively fixed electrode. Aims. (i) To determine whether the use of a primo-implanted pacemaker with an electrode system with active fixation will raise troponin levels over baseline. (ii) To assess whether troponin I elevation is dependent on procedure complexity. Methods. We enrolled 219 consecutive patients indicated for pacemaker primo-implantation; cardiospecific marker values (troponin I, CKMB, myoglobin) were determined before the implantation procedure and again at 6-and 18-h intervals after the procedure. We monitored duration of cardiac skiascopy, number of attempts to place the electrode (active penetration into the tissue) and intervention range (single-chamber versus dual-chamber pacing), and we assessed the clinical data. Results. The average age of the enrolled patients was 78.2 ± 8.0 years (median age, 80 years); women constituted 45% of the group. We implanted 128 dual-chamber and 91 single-chamber devices with an average skiascopic time of 38.6 ± 22.0 s (median, 33.5 s). Troponin I serum levels increased from an initial 0.03 ± 0.07 μg/L (median, 0.01) to 0.18 ± 0.17 μg/L (median, 0.13) and 0.09 ± 0.18 μg/L (median, 0.04) at 6 and 18 h, respectively. The differences were statistically significant (P < 0.001 or P < 0.001). We confirmed a correlation between troponin increase and duration of skiascopy (P < 0.001). We also demonstrated a correlation between increased troponin I and number of attempts to place a pacemaker electrode (penetration into the tissue) at 6 h (P < 0.001) post-implantation. Conclusion. We detected slightly elevated troponin I levels in patients with primo-implanted pacemakers using electrodes with active fixation. We demonstrated a direct correlation between myocardial damage (number of electrode penetrations into the myocardium) and troponin I elevation, as well as between complexity (severity) of the implantation procedure (indicated by prolonged skiascopy) and raised troponin I. The described phenomenon demonstrates the loss of the diagnostic role of troponin I early after pacemaker primo-implantation in patients with concomitant chest pain.

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“…We thank Dr. Roy et al for the interest in our recent paper 1 showing that ischemia‐modified albumin (IMA) levels increase during pacemaker and defibrillator implantation along with cardiac enzymes, implying ischemia, and subsequent necrosis in this setting. Indeed, to our surprise, we found no significant differences among the various subgroups (i.e., single vs dual lead, with or without coronary artery disease, short or long procedure); in all these subgroups IMA increased invariably.…”

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confidence: 99%

Response to the Letter by Dr. Roy

Sbarouni

2008

Pacing Clinical Electrophis

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The Ischemia‐Modified Albumin in Relation to Pacemaker and Defibrillator Implantation

Abstract: Permanent pacemaker-defibrillator insertion is associated with myocardial ischemia and necrosis.

Cited by 11 publications

References 23 publications

The Ischemia‐Modified Albumin in Relation to Pacemaker and Defibrillator Implantation: The Mechanism of IMA Formation and the Role of Reactive Oxygen Speciespt

The Ischemia‐Modified Albumin in Relation to Pacemaker and Defibrillator Implantation: The Mechanism of IMA Formation and the Role of Reactive Oxygen Speciespt

Factors underlying elevated troponin I levels following pacemaker primo-implantation

Response to the Letter by Dr. Roy

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