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@article{1359128,
author = {Hnatek, Tomas and Taborsky, Milos and Maly, Martin and Kamenik, Libor and Littnerová, Simona and Sedlon, Pavel and Luxova, Jana and Fiserova, Marta and Pospisilova, Lenka and Hamouzova, Sarka and Danek, Josef and Zavoral, Miroslav},
article_location = {Olomouc},
article_number = {2},
doi = {http://dx.doi.org/10.5507/bp.2015.067},
keywords = {cardiac pacing; troponin; primo-implantation; myocardial damage},
language = {eng},
issn = {1213-8118},
journal = {Biomedical Papers of the Faculty of Medicine of Palacký University},
title = {Factors underlying elevated troponin I levels following pacemaker primo-implantation},
volume = {160},
year = {2016}
}
TY - JOUR
ID - 1359128
AU - Hnatek, Tomas - Taborsky, Milos - Maly, Martin - Kamenik, Libor - Littnerová, Simona - Sedlon, Pavel - Luxova, Jana - Fiserova, Marta - Pospisilova, Lenka - Hamouzova, Sarka - Danek, Josef - Zavoral, Miroslav
PY - 2016
TI - Factors underlying elevated troponin I levels following pacemaker primo-implantation
JF - Biomedical Papers of the Faculty of Medicine of Palacký University
VL - 160
IS - 2
SP - 248-256
EP - 248-256
PB - Palacký University
SN - 12138118
KW - cardiac pacing
KW - troponin
KW - primo-implantation
KW - myocardial damage
N2 - Background. Cardiac troponins are routinely used as markers of myocardial damage. Originally, they were only intended for use in diagnosing acute coronary syndromes; however, we now know that raised serum troponin levels are not always caused by ischemia. There are many other clinical conditions that cause damage to cardiomyocytes, leading to raised levels of troponin. However, the specificity of cardiac troponins towards the myocardium is absolute. Our work focuses on mechanical damage to the myocardium and on monitoring the factors that raise the levels of cardiospecific markers after primo-implantation of a pacemaker with an actively fixed electrode. Aims. (i) To determine whether the use of a primo-implanted pacemaker with an electrode system with active fixation will raise troponin levels over baseline. (ii) To assess whether troponin I elevation is dependent on procedure complexity. Methods. We enrolled 219 consecutive patients indicated for pacemaker primo-implantation; cardiospecific marker values (troponin I, CKMB, myoglobin) were determined before the implantation procedure and again at 6- and 18-h intervals after the procedure. We monitored duration of cardiac skiascopy, number of attempts to place the electrode (active penetration into the tissue) and intervention range (single-chamber versus dual-chamber pacing), and we assessed the clinical data. Results. The average age of the enrolled patients was 78.2 +/- 8.0 years (median age, 80 years); women constituted 45% of the group. We implanted 128 dual-chamber and 91 single-chamber devices with an average skiascopic time of 38.6 +/- 22.0 s (median, 33.5 s). Troponin I serum levels increased from an initial 0.03 +/- 0.07 mu g/L (median, 0.01) to 0.18 +/- 0.17 mu g/L (median, 0.13) and 0.09 +/- 0.18 mu g/L (median, 0.04) at 6 and 18 h, respectively. The differences were statistically significant (P < 0.001 or P < 0.001). We confirmed a correlation between troponin increase and duration of skiascopy (P < 0.001). We also demonstrated a correlation between increased troponin I and number of attempts to place a pacemaker electrode (penetration into the tissue) at 6 h (P < 0.001) post-implantation. Conclusion. We detected slightly elevated troponin I levels in patients with primo-implanted pacemakers using electrodes with active fixation. We demonstrated a direct correlation between myocardial damage (number of electrode penetrations into the myocardium) and troponin I elevation, as well as between complexity (severity) of the implantation procedure (indicated by prolonged skiascopy) and raised troponin I. The described phenomenon demonstrates the loss of the diagnostic role of troponin I early after pacemaker primo-implantation in patients with concomitant chest pain.
ER -
HNATEK, Tomas, Milos TABORSKY, Martin MALY, Libor KAMENIK, Simona LITTNEROVÁ, Pavel SEDLON, Jana LUXOVA, Marta FISEROVA, Lenka POSPISILOVA, Sarka HAMOUZOVA, Josef DANEK a Miroslav ZAVORAL. Factors underlying elevated troponin I levels following pacemaker primo-implantation. \textit{Biomedical Papers of the Faculty of Medicine of Palacký University}. Olomouc: Palacký University, 2016, roč.~160, č.~2, s.~248-256. ISSN~1213-8118. Dostupné z: https://dx.doi.org/10.5507/bp.2015.067.
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