Key result
ICD implantation alone or with testing significantly increased hs-TnT levels (median increase 96% and 161%, P=0.005), whereas defibrillation testing alone caused no significant change.
Why the study?
Does defibrillation testing during ICD implantation cause myocardial injury independent of lead deployment?
Observational (n=37)
Does defibrillation testing during ICD implantation cause myocardial injury independent of lead deployment?
p-value: p=0.005
Myocardial injury observed during ICD procedures is primarily associated with lead deployment rather than the defibrillation shocks themselves.
ICD lead placement—not defibrillation testing—drives troponin release; leaves open whether routine testing can be safely omitted.
AIMS: Previous studies have reported the defibrillation testing during implantable cardioverter defibrillator (ICD) implantation is associated with elevated cardiac biomarkers and ST-segment electrocardiogram (ECG) changes suggesting that shocks during testing may cause harm. However, the effects of testing have not been isolated from the implant procedure itself, where lead deployment may cause myocardial damage. This prospective study examined high sensitivity troponin T (hs-TnT) levels and ECG changes during ICD implanting alone, ICD implantation with testing and device testing as a stand-alone procedure. METHODS AND RESULTS: We examined hs-TnT at baseline, and 6-8 h post procedure and 12 lead ECG at baseline, and 30 s, 5 min, and 10 min post right ventricle lead deployment and post defibrillation. There was no significant change in hs-TnT levels in a group of patients (n = 11) undergoing defibrillation testing alone, while hs-TnT was significantly elevated in patients undergoing implantation alone (n = 13, median increase 96%, P = 0.005) and in patients undergoing implantation and testing (n = 13, median increase 161%, P = 0.005). There was a significant correlation between the number of lead deployments and the percentage change in hs-TnT (r = -0.51, P = 0.01), but no correlation between either the number of shocks (r = 0.26, P = 0.25) or the total delivered energy (r = 0.24, P = 0.30) and percentage change in hs-TnT. CONCLUSION: Implantation of ICD leads was associated with release of troponin, but we did not observe any evidence that ICD shocks alone cause myocardial injury.
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Furniss et al. (2014) conducted an observational in Implantable cardioverter defibrillator (ICD) implantation (n=37). ICD implantation (with or without testing) vs. Defibrillation testing alone was evaluated on Change in high sensitivity troponin T (hs-TnT) levels (p=0.005). ICD implantation alone or with testing significantly increased hs-TnT levels (median increase 96% and 161%, P=0.005), whereas defibrillation testing alone caused no significant change.
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