Cardiac dysfunction and prolonged hemodynamic deterioration after implantable cardioverter-defibrillator shock in patients with systolic heart failure

Norihisa Toh, Nobuhiro Nishii, Kazufumi Nakamura, Takeshi Tada, Hiroki Oe, Satoshi Nagase, Kunihisa Kohno, Hiroshi Morita, Kengo F. Kusano, Hiroshi Ito

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: We investigated the acute effects of implantable cardioverter-defibrillator shock on myocardium, cardiac function, and hemodynamics in relation to left ventricular systolic function. Methods and Results: We studied 50 patients who underwent implantable cardioverter- defibrillator implantation and defibrillation threshold (DFT) testing: 25 patients with left ventricular ejection fraction (LVEF) ≥45% and 25 patients with LVEF <45%. We measured cardiac biomarkers (creatine kinase, creatine kinase-MB, myoglobin, cardiac troponin T and I, and N-terminal probrain natriuretic peptide). Left ventricular relaxation was assessed by global longitudinal strain rate during the isovolumetric relaxation period using speckle-tracking echocardiography. Blood sampling and echocardiography were performed before, immediately after, and 5 minutes and 4 hours after DFT testing. Mean arterial pressure was measured directly during DFT testing. Cardiac biomarkers showed no significant changes in either group. LVEF was decreased until 5 minutes after DFT testing and had recovered to the baseline at 4 hours in the group with reduced LVEF (P<0.001), whereas LVEF reduction was not observed in the group with preserved LVEF (P=0.637). Global isovolumetric relaxation period was decreased until 5 minutes after DFT testing and had recovered to the baseline at 4 hours in both groups (preserved LVEF: 0.39±0.14 versus 0.23±0.13 versus 0.23±0.13 versus 0.40±0.13 s-1, *P<0.001 versus baseline; reduced LVEF: 0.15±0.05 versus 0.08±0.04† versus 0.09±0.04† versus 0.15±0.05 s-1, †P<0.001 versus baseline, repeated-measures ANOVA). Time to recovery of mean arterial pressure to the baseline was prolonged in the group with reduced LVEF (P<0.001). Conclusions: Implantable cardioverter-defibrillator shock transiently impairs cardiac function and hemodynamics especially in patients with systolic dysfunction, although significant tissue injury is not observed.

Original languageEnglish
Pages (from-to)898-905
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume5
Issue number5
DOIs
Publication statusPublished - Oct 1 2012

Keywords

  • Cardiac function
  • Echocardiography
  • Hemodynamics
  • Implanted cardioverter defibrillators
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Cardiac dysfunction and prolonged hemodynamic deterioration after implantable cardioverter-defibrillator shock in patients with systolic heart failure'. Together they form a unique fingerprint.

  • Cite this