Evaluation of Changes in Cardiac Troponin I Levels After Direct Current Cardioversion in Patients With Atrial Fibrillation

TL;DR

This study found that direct current cardioversion for atrial fibrillation does not cause heart muscle injury, based on unchanged levels of a heart injury marker.

Contribution

The study provides new evidence that synchronized DCCV using a biphasic defibrillator does not induce myocardial injury.

Findings

Cardiac troponin I levels remained unchanged (<0.1 ng/mL) after DCCV at all measured time points.

There was no correlation between cTnI levels and the energy delivered during DCCV.

The outcome of AF reversion correlated with the energy used, but not with cTnI levels.

Abstract

Introduction: Direct current cardioversion (DCCV) of atrial fibrillation (AF) is a procedure used to restore normal heart rhythm. Cardiac biomarkers, such as cardiac troponin I (cTnI), are elevated in situations where injury-myocardial cell necrosis is induced.

Aim: The aim of the present study was to investigate the change in cTnI levels, i.e., whether a myocardial injury is present, in patients with AF whose elective treatment was synchronized DCCV via a biphasic defibrillator.

Methods: The study sample included 59 patients who underwent synchronized DCCV for AF reversion. Measurement of cTnI before and after DCCV (one, three, and six hours) was performed by blood sampling and subsequent assay.

Results: It was observed that the value of cTnI did not change (<0.1 ng/mL) after DCCV at the measurement time points (one, three, and six hours). In addition, the value of cTnI remained constant (<0.1 ng/mL) in relation to the energy delivered, before DCCV and after DCCV (one, three, and six hours). However, it was found that there was a correlation between the outcome (AF reversion or not) and the energy used (joules).

Conclusions: Synchronized DCCV with a biphasic defibrillator did not cause myocardial injury in any of the patients, as there was no change in cTnI values before and after DCCV.

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