Release of high-sensitive TROPonin T by implantation of an entirely subcutaneous Implantable Cardioverter-defibrillator
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Release of high-sensitive TROPonin T by implantation of an entirely subcutaneous Implantable Cardioverter-defibrillator compared to a conventional transvenous approach: the TROPIC registry Severin Weigand 1,2 & Matthew O’Connor 3 & Patrick Blažek 1 & Verena Kantenwein 1 & Lena Friedrich 1 & Christian Grebmer 4 & Claudia Schaarschmidt 1 & Gesa von Olshausen 5 & Tilko Reents 1 & Isabel Deisenhofer 1 & Carsten Lennerz 1,2 & Christof Kolb 1 Received: 14 May 2020 / Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Subcutaneous implantable cardioverter-defibrillator . Myocardial damage . High-sensitive troponin T . Defibrillation threshold testing
* Severin Weigand [email protected] 1
Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
2
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
3
Department of Cardiology, Wellington Hospital, Wellington, New Zealand
4
Abteilung für Elektrophysiologie, Kantonsspital Luzern, Herzzentrum, Lucerne, Switzerland
5
Medizinische Klinik I, Klinikum rechts der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany
Abbreviations ATP Anti-tachycardia pacing CK Creatine kinase total CK-MB Creatine kinase muscle brain frac
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