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Threshold energy dose for enzyme release after direct-current countershock

G Gheno¹, R Zeppellini, R De Domenico

¹Department of Cardiology, Bassano General Hospital, Vicenza, Italy.

International Journal of Cardiology

|July 26, 1996

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DC countershock can increase creatine kinase (CK) and CK-MB isoenzyme levels. This study determined the energy thresholds for enzyme release, offering insights to prevent muscle damage and aid diagnosis.

Area of Science:

Cardiology
Biochemistry

Background:

Direct current (DC) countershock is used for atrial arrhythmias.
Enzyme release, particularly creatine kinase (CK) and CK-MB isoenzyme, is a known complication of DC countershock.
The energy threshold for this enzyme release has not been previously defined.

Purpose of the Study:

To prospectively determine the energy threshold for creatine kinase (CK) and CK-MB isoenzyme release following DC countershock.
To investigate the correlation between energy dose and enzyme release.
To establish reference values for enzyme release to aid clinical diagnosis.

Main Methods:

Serial photometric assays of serum total CK and CK-MB isoenzyme were performed in 82 patients post-elective DC countershock.
Energy dose was individually titrated using an anterolateral paddle-electrode location.

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Parameters measured included shock number, peak energy, and cumulative energy dose normalized to body weight.

Main Results:

All measured energy parameters showed a significant positive correlation with enzyme release (P < 0.0001).
Enzyme levels peaked approximately 16 hours after countershock.
The estimated energy threshold for enzyme release was around 4 J/kg for total CK and 6 J/kg for CK-MB isoenzyme.

Conclusions:

Specific energy thresholds for creatine kinase and CK-MB isoenzyme release following DC countershock have been identified.
These thresholds can help clinicians avoid unnecessary muscle damage.
The findings provide a reference for interpreting enzyme elevations that might otherwise complicate the diagnosis of acute myocardial infarction.