Cardioversión eléctrica externa y sistemas de cardioversión interna: evaluación prospectiva y comparativa del daño celular con troponina I

Sánchez, José M del Rey; Madrid, Antonio Hernández; Rebollo, J.M. González; Pérez, Gonzalo; Rodríguez, Aníbal; Savova, Detelina; Calabria, Lucas Cano; Cabeza, Pedro; Pérez, José Duarte; Gómez‐Bueno, Manuel; Mercader, José Güell y; Ripoll, Eduardo; Moro, Concepción

doi:10.1016/s0300-8932(02)76590-1

Cited by 9 publications

(2 citation statements)

References 25 publications

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“…In a meta-analysis of studies after external cardioversions only 7 of 442 patients and 1 of 368 patients showed an increase in cardiac Troponin I and T, respectively [19]. Additionally, myoglobin levels and creatine kinase (CK) activity are non-specific markers for muscle injury and an increase in these markers after transthoracic shocks therefore is not reliable proof of myocardial injury and may be also attributed to skeletal muscle injury [2,4,20]. …”

Section: Discussionmentioning

confidence: 99%

Evidence for Acute Myocardial and Skeletal Muscle Injury after Serial Transthoracic Shocks in Healthy Swine

Guensch

Nadeshalingam

et al. 2016

PLoS ONE

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BackgroundPrevious serological studies have shown controversial results whether defibrillation or cardioversion can cause myocardial injury. Cardiovascular Magnetic Resonance (CMR) can be used to detect myocardial edema, hyperemia and capillary leak as features of acute myocardial injury. The aim of this study was to assess for myocardial and skeletal muscle injury in swine following transthoracic shocks.MethodsSeventeen anaesthetized swine were examined, with 11 undergoing five synchronized transthoracic shocks (200J). Myocardial and skeletal muscle injury were assessed at baseline and up to 5h post-shock employing T1 mapping, T2 mapping, early and late gadolinium enhancement. Serologic markers (cFABP, TnI, CK, and CK-MB) and myocardial tissue were assessed by standard histology methods.ResultsIn myocardial regions within the shock path, T1 and T2 were significantly increased compared to remote myocardium in the same animals. The early gadolinium enhancement ratio between the left-ventricular myocardium and the right pectoral muscle was also increased compared to control animals. After the shocks cFABP and CK were significantly elevated. After shock application, the regions identified as abnormal by CMR showed significantly increased interstitial and myocardial cell areas in histological analysis. This increased cell area suggests significant cellular and interstitial edema.ConclusionOur pilot study data indicate that serial defibrillator shocks lead to acute skeletal muscle and myocardial injury. CMR is a useful tool to detect and localize myocardial and skeletal muscle injury early after transthoracic shocks in vivo. In the future the technique could potentially be used as an additional tool for quality control such as verifying insufficient local shock application in non-responders after cardioversion or to develop safer shock forms.

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Section: Discussionmentioning

confidence: 99%

Evidence for Acute Myocardial and Skeletal Muscle Injury after Serial Transthoracic Shocks in Healthy Swine

Guensch

Nadeshalingam

et al. 2016

PLoS ONE

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“…Por lo tanto para la cardioversión en adultos, tanto los electrodos de palas metálicas de mano como electrodos de parche autoadhesivos de 8 a 12 cm de diámetro resultan útiles. Por otro lado, electrodos pequeños 4.3 cm pueden ser peligrosos (por concentrar una mayor densidad de corriente por área de superficie) y pueden causar necrosis miocárdica (25,26).…”

Section: Cardioversión Eléctricaunclassified

Cardioversión eléctrica y cardioversión farmacológica en pacientes con fibrilación auricular

et al. 2020

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La fibrilación auricular altera la función hemodinámica del corazón, siendo un factor de riesgo de accidentes tromboembólicos, complicaciones y síntomas relacionados con la propia arritmia cardiaca. Restituir o conservar el ritmo sinusal es una parte importante en su manejo, para ello se establece dos tipos de Restitución, mediante una descarga eléctrica y mediante el uso de fármacos, las cuales son válidas, sin embargo existe aspectos importantes a considerar. El objetivo de este trabajo es comparar las características e indicaciones del empleo de cardioversión eléctrica y farmacológica en pacientes con fibrilación auricular. Se realizó una comparación entre ambas considerando características propias de cada método, técnicas, mecanismo, puntos importantes a tomar en cuenta, indicaciones, complicaciones y efectividad. La elección idónea del paciente y la técnica adecuada es significativo para restaurar un ritmo cardiaco normal. Ambas presentan características específicas y limitaciones. Al momento de actuar no hay procedimiento que pueda considerarse óptimo es necesario en algunas veces recurrir a una estrategia combinada se ha revisado que la prescripción de medicamentos antiarrítmicos antes de una cardioversión eléctrica puede ser útil para aumentar el éxito y prevenir. Conflictos de InteresesLos autores declaramos no tener conflictos de interés para el presente estudio.

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

et al. 2005

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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.

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Cardioversión eléctrica externa y sistemas de cardioversión interna: evaluación prospectiva y comparativa del daño celular con troponina I

Cited by 9 publications

References 25 publications

Evidence for Acute Myocardial and Skeletal Muscle Injury after Serial Transthoracic Shocks in Healthy Swine

Evidence for Acute Myocardial and Skeletal Muscle Injury after Serial Transthoracic Shocks in Healthy Swine

Cardioversión eléctrica y cardioversión farmacológica en pacientes con fibrilación auricular

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

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