Impact of internal and external electrical cardioversion on cardiac specific enzymes and inflammation in patients with atrial fibrillation and heart failure

• Published in: Journal of cardiology 2018-08, Vol.72 (2), p.135-139
• Main Authors: Stieger, Philipp, Rana, Obaida R., Saygili, Erol, Zazai, Haschmatulla, Rauwolf, Thomas, Genz, Conrad, Bali, Rajen, Braun-Dullaeus, Ruediger C., Said, Samir M.
• Format: Article
• Language: English
• Subjects: Atrial fibrillation; Implantable cardioverter defibrillator; Implantable cardioverter defibrillator shocks; Interleukin-6; Troponin
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2018.01.016

•The aim was to evaluate if internal or external cardioversion (CV) induces myocardial injury.•We concluded that internal CV induces an inflammatory response.•External CV is not associated with significant myocardial damage.•External CV is more effective than internal CV in our clinical setup. Implantable cardioverter/defibrillator (ICD) shocks can cause myocardial injury, contributing to the progression of the underlying heart disease. The aim was to evaluate whether internal electrical cardioversion (int-CV) via the ICD or conventional external CV (ext-CV) of persistent atrial fibrillation (AF) in heart failure (HF) patients induces myocardial injury and initiates inflammation. A total of 115 HF patients with an ejection fraction between 20% and 45% were prospectively enrolled. Fifty-one patients were excluded due to failure of electrical CV at the first attempt as well as early relapse of AF within 8h after CV. The int-CV group consisted of 22 and the ext-CV group of 42 patients. Baseline values of high sensitive troponin T (hsTnT), interleukin (IL)-6, and C-reactive protein (CRP) did not differ significantly in both groups, whereas baseline N-terminal pro B-type natriuretic peptide (NT-pro BNP) was significantly lower in the ext-CV group. Eight hours after CV, the level of hsTnT increased significantly in the int-CV group, whereas no significant change was observed in the ext-CV group. Furthermore, CV significantly increased IL-6 and CRP in the int-CV group, whereas an insignificant increase could be documented in the ext-CV group. Due to electrical CV in both groups, the NT-pro BNP levels significantly declined in approximately the same content (int-CV 29% vs. ext-CV 36%). The significant increase in hsTnT, IL-6, and CRP in patients who underwent int-CV compared to those undergoing ext-CV may suggest that int-CV causes significant myocardial damage and induces systemic inflammation.