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Clementy N, Bodin A, Bisson A, Teixeira-Gomes AP, Roger S, Angoulvant D, Labas V, Babuty D. The Defibrillation Conundrum: New Insights into the Mechanisms of Shock-Related Myocardial Injury Sustained from a Life-Saving Therapy. Int J Mol Sci 2021; 22:5003. [PMID: 34066832 PMCID: PMC8125879 DOI: 10.3390/ijms22095003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Implantable cardiac defibrillators (ICDs) are recommended to prevent the risk of sudden cardiac death. However, shocks are associated with an increased mortality with a dose response effect, and a strategy of reducing electrical therapy burden improves the prognosis of implanted patients. We review the mechanisms of defibrillation and its consequences, including cell damage, metabolic remodeling, calcium metabolism anomalies, and inflammatory and pro-fibrotic remodeling. Electrical shocks do save lives, but also promote myocardial stunning, heart failure, and pro-arrhythmic effects as seen in electrical storms. Limiting unnecessary implantations and therapies and proposing new methods of defibrillation in the future are recommended.
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Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Alexandre Bodin
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
| | - Arnaud Bisson
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Ana-Paula Teixeira-Gomes
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Sebastien Roger
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Denis Angoulvant
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Valérie Labas
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Dominique Babuty
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
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Weigand S, O'Connor M, Blažek P, Kantenwein V, Friedrich L, Grebmer C, Schaarschmidt C, von Olshausen G, Reents T, Deisenhofer I, Lennerz C, Kolb C. Release of high-sensitive TROPonin T by implantation of an entirely subcutaneous Implantable Cardioverter-defibrillator compared to a conventional transvenous approach: the TROPIC registry. J Interv Card Electrophysiol 2020; 62:75-81. [PMID: 32959177 DOI: 10.1007/s10840-020-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has become an alternative option when a conventional transvenous approach is not suitable. The myocardial damage caused by S-ICD implantation appears to be minimal despite mandatory defibrillation threshold (DFT) testing. However, there has not been a direct comparison with the traditional transvenous placement of a single-chamber ICD (VVI-ICD). The aim of this study was to determine the extent of myocardial damage by analysing the changes in serum levels of cardiac enzymes after S-ICD implantation in comparison with VVI-ICD. METHODS In 43 patients who received an S-ICD system, differences in serum levels of high-sensitive troponin T (ΔhsTnT) and creatine kinase total (ΔCK) and muscle brain fraction (ΔCK-MB) were acquired by blood sampling before and the day after implantation. The control group consisted of 43 patients from the TropShock study who had received a transvenous VVI-ICD without DFT. RESULTS After S-ICD implantation and testing procedure, ΔhsTnT (0.000 ng/ml, IQR - 0.003-0.002 ng/ml) was significantly lower than after conventional VVI-ICD implantation (0.018 ng/ml, IQR 0.004-0.032 ng/ml; p < 0.001). There was no significant difference in CK (ΔCKS-ICD 85.0 U/I, IQR 30.5-225.8 U/I vs ΔCKVVI-ICD 69.5 U/I, IQR 22.9-172.3 U/I; p = 0.357), but there was a significant difference in CK-MB (ΔCK-MBS-ICD of - 0.60, IQR - 2.60-1.0 vs ΔCK-MBVVI-ICD 1.0, IQR - 1.08-3.18; p = 0.030). CONCLUSION S-ICD implantation causes less myocardial damage than VVI-ICD implantation evidenced by ΔhsTnT and ΔCK-MB.
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Affiliation(s)
- Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Matthew O'Connor
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Patrick Blažek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Verena Kantenwein
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Lena Friedrich
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Christian Grebmer
- Abteilung für Elektrophysiologie, Kantonsspital Luzern, Herzzentrum, Lucerne, Switzerland
| | - Claudia Schaarschmidt
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Gesa von Olshausen
- Medizinische Klinik I, Klinikum rechts der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
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Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant? Neth Heart J 2020; 28:122-127. [PMID: 32780342 PMCID: PMC7419406 DOI: 10.1007/s12471-020-01448-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since the publication of the SIMPLE and NORDIC trials, defibrillation testing (DFT) is rarely performed during routine implantation of transvenous implantable cardioverter-defibrillators (ICD). However, the results of these trials cannot be extrapolated to the later introduced subcutaneous ICD (S-ICD) and a class I recommendation to perform DFT during the implantation of these devices remains in the current guidelines. Due to the high conversion success rate of DFT on one hand, and the risk of complications on the other, a significant number of physicians omit DFT in S‑ICD recipients. Several retrospective analyses have assessed the safety of the omission of DFT and report contradicting results and recommendations. It is known that implant position, as well as device factors and patient characteristics, influence defibrillation success. A better comprehension of these factors and their relationship could lead to more reliable and safer alternatives to DFT. An ongoing randomised clinical trial, which is expected to end in 2023, is the first study to implement a method that assesses implant position to identify patients who are likely to fail their DFT.
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Ara F, Mellor G, Grace A. Editorial commentary: Sudden death prevention post-myocardial infarction and afterVEST. Trends Cardiovasc Med 2020; 31:202-203. [PMID: 32434042 DOI: 10.1016/j.tcm.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Farhana Ara
- Royal Papworth Hospital Foundation Trust, Cambridge Biomedical Campus, Cambridge CB4 0AY, United Kingdom
| | - Greg Mellor
- Royal Papworth Hospital Foundation Trust, Cambridge Biomedical Campus, Cambridge CB4 0AY, United Kingdom
| | - Andrew Grace
- Royal Papworth Hospital Foundation Trust, Cambridge Biomedical Campus, Cambridge CB4 0AY, United Kingdom; Department of Biochemistry, Tennis Court Road, University of Cambridge, Cambridge CB2 1QW, United Kingdom.
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D'Onofrio A, Russo V, Bianchi V, Cavallaro C, Leonardi S, De Vivo S, Vecchione F, Rago A, Ammendola E, Tavoletta V, Atripaldi L, Mocavero PE, Nigro G. Effects of defibrillation shock in patients implanted with a subcutaneous defibrillator: a biomarker study. Europace 2019; 20:f233-f239. [PMID: 29095967 PMCID: PMC6140430 DOI: 10.1093/europace/eux330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Implantable cardioverter defibrillator (ICD) shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after defibrillation testing (DFT). In an experimental swine study, subcutaneous ICD (S-ICD) shocks caused less myocardial damage than traditional ICD shocks. The aim of our study was to investigate the association between S-ICD shock and acute cardiac damage in humans, as evaluated by means of sensitive and highly specific circulating biomarkers. Methods and results We calculated the variation in the serum levels of high-sensitivity cardiac troponin I (hs-CTnI) and creatine kinase-MB mass concentration (CK-MB mass), measured before and after an S-ICD shock delivered during intraoperative DFT. We also measured the degree of haemodynamic stress, as the variation in the serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and copeptin (CP), after the S-ICD shock. We analysed 30 consecutive patients who received an S-ICD and who underwent DFT by means of a single 65 J shock. The levels of biomarkers did not change from baseline to 1 h post-shock, i.e. hs-CTnI (from 0.029 ± 0.005 ng/mL to 0.030 ± 0.005 ng/mL, P = 0.079) and CK-MB mass (from 1.37 ± 0.17 ng/mL to 1.41 ± 0.18, P = 0.080) and remained stable 6 and 24 h after DFT. The plasma NT-proBNP did not change, whereas CP levels were significantly higher at 1 h post-shock evaluation. However, 6 h after DFT, the levels had returned to the baseline and remained stable at 24 h. Conclusion The S-ICD shock did not seem to cause myocardial injuries. Although CP levels temporarily rose after DFT, they returned to basal levels within 6 h, which suggests that DFT does not have long-term prognostic implications. ICD shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after DFT. We showed that serum levels of biomarkers of myocardial damage did not increase after high-energy DFT in patients who had undergone S-ICD device implantation. This suggests that S-ICD shock does not have long-term prognostic implications.
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Affiliation(s)
- Antonio D'Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Vincenzo Russo
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Valter Bianchi
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Ciro Cavallaro
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Silvia Leonardi
- Hematology and Cellular Immunology (Clinical Biochemistry), Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Stefano De Vivo
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Filippo Vecchione
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Ernesto Ammendola
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Vincenzo Tavoletta
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Luigi Atripaldi
- Hematology and Cellular Immunology (Clinical Biochemistry), Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Paola Elvira Mocavero
- Post Operative Intensive Care Unit, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
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Darrat YH, Benn F, Salih M, Shah J, Parrott K, Morales GX, Gurley JC, Elayi CS. Single incision technique for implantation of subcutaneous implantable cardioverter defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1543-1548. [DOI: 10.1111/pace.13506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/25/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yousef H. Darrat
- Gill Heart Institute and VAMC, Cardiology; University of Kentucky; Lexington KY USA
| | - Francis Benn
- Gill Heart Institute and VAMC, Cardiology; University of Kentucky; Lexington KY USA
| | - Mohsin Salih
- Gill Heart Institute and VAMC, Cardiology; University of Kentucky; Lexington KY USA
| | | | - Kevin Parrott
- Gill Heart Institute and VAMC, Cardiology; University of Kentucky; Lexington KY USA
| | - Gustavo X. Morales
- Gill Heart Institute and VAMC, Cardiology; University of Kentucky; Lexington KY USA
| | - John C. Gurley
- Gill Heart Institute and VAMC, Cardiology; University of Kentucky; Lexington KY USA
| | - Claude-Samy Elayi
- Gill Heart Institute and VAMC, Cardiology; University of Kentucky; Lexington KY USA
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