Effects of transvenous pacing on cardiac troponin release
Christopher J Boos1, Sophie Gough, Matthew Wheather
1Department of Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom. christopherboos@hotmail.com
Insights
Permanent pacemaker insertion can cause a small rise in cardiac troponin I (cTnI) levels in some patients. Prolonged X-ray screening time during lead implantation was the only factor correlated with this minimal myocardial injury detection.
Area of Science:
- Cardiology
- Biomarkers
- Medical Devices
Background:
- Cardiac troponins are crucial for detecting myocardial injury.
- The impact of permanent cardiac pacing on troponin measurements is not well-documented.
Purpose of the Study:
- To assess the effect of permanent cardiac pacing on cardiac troponin I (cTnI) levels.
- To identify factors influencing minimal myocardial injury detection post-pacemaker implantation.
Main Methods:
- Investigated 76 patients undergoing elective pacemaker insertion.
- Measured cTnI, AST, and CK before and 18-21 hours after implantation.
- Analyzed correlation between troponin rise and procedural factors like X-ray screening time.
Main Results:
- A small, detectable rise in cTnI above normal occurred in 21% of patients post-implantation.
- The mean post-implantation cTnI level was 0.39 +/- 0.37 microg/L (normal < 0.15 microg/L).
- Prolonged X-ray screening time was the sole factor correlating with the cTnI rise.
Conclusions:
- Permanent pacemaker insertion can lead to transient, minimal myocardial injury detectable by cTnI.
- X-ray screening time during lead implantation is a significant factor influencing cTnI levels post-procedure.
Abstract:
Cardiac troponins are invaluable tools for the detection of minimal myocardial injury. No study to date has analyzed the effect of permanent cardiac pacing on minimal myocardial injury detection by cardiac troponin I (cTnI) measurement. We investigated 76 clinically stable patients (mean age 75 years, range 31-93 years, 59% men) listed for elective endocardial permanent pacemaker insertion. Patients were required to have normal levels of cardiac cTnI, aspartate transaminase (AST) and creatinine kinase (CK) on a venous blood sample taken immediately prior to elective pacemaker implantation. Repeat measurements of AST, CK, and cTnI were performed at a mean of 19.2 post implantation. There was a detectable small rise in cTnI levels above normal in 21% of patients in a second blood sample taken 18-21 hours later (mean cTnI 0.39 +/- 0.37 microg/L, normal < 0.15 microg/L). The only factor that correlated with this rise was prolonged x ray screening time for lead implantation.
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