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Absence of significant myocardial injury following elective direct current cardioversion for atrial fibrillation

Ronstan Lobo1, Roger D White1,2, Leslie J Donato3

  • 1Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.

Heart Rhythm O2
|March 30, 2023
PubMed

Insights

Direct current (DC) cardioversion for arrhythmias causes minor troponin changes in most patients. Myocardial injury from DC cardioversion is rare, occurring in only 2% of cases studied.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Biomarkers

Background:

  • Direct current (DC) cardioversion is a standard procedure for terminating cardiac arrhythmias.
  • Current guidelines suggest cardioversion may cause myocardial injury.

Purpose of the Study:

  • To investigate whether external DC cardioversion leads to myocardial injury.
  • To assess myocardial injury using serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI).

Main Methods:

  • Prospective study of patients undergoing elective external DC cardioversion for atrial fibrillation.
  • hs-cTnT and hs-cTnI levels measured before and at least 6 hours after cardioversion.
  • Myocardial injury defined by significant changes in both hs-cTnT and hs-cTnI.

Main Results:

  • 98 subjects analyzed; median cumulative energy 121.9 J, with 23.5% receiving ≥300 J.
  • Small, statistically significant increases observed in both hs-cTnT and hs-cTnI post-cardioversion (P < .001).
  • Only 2% of patients met the criteria for myocardial injury, irrespective of shock energy or baseline levels.

Conclusions:

  • DC cardioversion causes minimal, statistically significant troponin level changes in a small percentage of patients.
  • Myocardial injury directly attributable to elective cardioversion is uncommon.
  • Marked troponin elevations post-cardioversion warrant investigation for alternative causes of myocardial injury.
Abstract

Keywords:
Atrial fibrillationCardioversionHigh-sensitivity cardiac troponinMyocardial injuryTroponin

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