除颤阈值测试后，ICD电击而非室颤导致高敏肌钙蛋白T升高——前瞻性、随机、多中心TropShock试验
ICD Shock, Not Ventricular Fibrillation, Causes Elevation of High Sensitive Troponin T after Defibrillation Threshold Testing--The Prospective, Randomized, Multicentre TropShock-Trial.
作者信息
Semmler Verena, Biermann Jürgen, Haller Bernhard, Jilek Clemens, Sarafoff Nikolaus, Lennerz Carsten, Vrazic Hrvoje, Zrenner Bernhard, Asbach Stefan, Kolb Christof
机构信息
Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany.
出版信息
PLoS One. 2015 Jul 24;10(7):e0131570. doi: 10.1371/journal.pone.0131570. eCollection 2015.
BACKGROUND
The placement of an implantable cardioverter defibrillator (ICD) has become routine practice to protect high risk patients from sudden cardiac death. However, implantation-related myocardial micro-damage and its relation to different implantation strategies are poorly characterized.
METHODS
A total of 194 ICD recipients (64±12 years, 83% male, 95% primary prevention of sudden cardiac death, 35% cardiac resynchronization therapy) were randomly assigned to one of three implantation strategies: (1) ICD implantation without any defibrillation threshold (DFT) testing, (2) estimation of the DFT without arrhythmia induction (modified "upper limit of vulnerability (ULV) testing") or (3) traditional safety margin testing including ventricular arrhythmia induction. High-sensitive Troponin T (hsTnT) levels were determined prior to the implantation and 6 hours after.
RESULTS
All three groups showed a postoperative increase of hsTnT. The mean delta was 0.031±0.032 ng/ml for patients without DFT testing, 0.080±0.067 ng/ml for the modified ULV-testing and 0.064±0.056 ng/ml for patients with traditional safety margin testing. Delta hsTnT was significantly larger in both of the groups with intraoperative ICD testing compared to the non-testing strategy (p≤0.001 each). There was no statistical difference in delta hsTnT between the two groups with intraoperative ICD testing (p = 0.179).
CONCLUSION
High-sensitive Troponin T release during ICD implantation is significantly higher in patients with intraoperative ICD testing using shock applications compared to those without testing. Shock applications, with or without arrhythmia induction, did not result in a significantly different delta hsTnT. Hence, the ICD shock itself and not ventricular fibrillation seems to cause myocardial micro-damage.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01230086.
背景
植入式心脏复律除颤器（ICD）的植入已成为保护高危患者预防心源性猝死的常规做法。然而，植入相关的心肌微损伤及其与不同植入策略的关系尚未得到充分描述。
方法
总共194例ICD植入患者（64±12岁，83%为男性，95%为心源性猝死一级预防，35%接受心脏再同步治疗）被随机分配到三种植入策略之一：（1）不进行任何除颤阈值（DFT）测试的ICD植入；（2）不诱发心律失常的DFT估计（改良的“易损性上限（ULV）测试”）；或（3）包括诱发室性心律失常的传统安全边际测试。在植入前和植入后6小时测定高敏肌钙蛋白T（hsTnT）水平。
结果
所有三组患者术后hsTnT均升高。未进行DFT测试的患者平均变化值为0.031±0.032 ng/ml，改良ULV测试患者为0.080±0.067 ng/ml，传统安全边际测试患者为0.064±0.056 ng/ml。与未测试策略相比，术中进行ICD测试的两组患者hsTnT变化值均显著更大（每组p≤0.001）。术中进行ICD测试的两组之间hsTnT变化值无统计学差异（p = 0.179）。
结论
与未进行测试的患者相比，术中使用电击应用进行ICD测试的患者在ICD植入期间高敏肌钙蛋白T释放显著更高。无论是否诱发心律失常，电击应用均未导致hsTnT变化值有显著差异。因此，似乎是ICD电击本身而非室颤导致心肌微损伤。
试验注册
ClinicalTrials.gov NCT01230086。
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