Abstract 18748: Myocardial Injury is Detectable in Virtually All Patients Undergoing Pacemaker Implantation
BACKGROUND: Cardiac troponin (CTn) measurement is the standard for diagnosing myocardial infarctions. CTn is also elevated by cardiac procedures. During pacemaker implantation (PMI), the extent and course of this elevation, as well as its prognostic significance using modern sensitive assays, is not known.
METHODS: In consecutive patients with normal LV function, normal renal function and no significant valvular disease referred for PMI, troponin I (TI) levels were determined at baseline (T0), 2-4 (T1), 6-12 (T2) and 12-24 hours (T3) post PMI using a commercially available assay (normal range <0.014-0.44 ng/ML). Since a significant number of patients had undetectable TI at baseline, TI at T0 and T1 were coded as normal or abnormal then compared using the Chi square statistic while the TI levels between T1, T2 and T3 were compared by ANOVA.
RESULTS: 34 patients (20 male, mean age 75.2±7.98 years, known CAD 23.5%, DM 36.1%, mean creatinine = 1.12±0.66 mg/Dl) underwent PMI using active fixation leads. At T0 70.5% of patients had undetectable levels, 85.3% had normal levels and 15% had elevated TI levels. 97% underwent dual chamber PMI. 33/34 patients (97%) had an abnormally elevated TI post procedure. The TI at T1 was significantly elevated versus T0 (?=32, p< 0.0001). TI remained elevated 24 hours post PMI, with no significant difference in TI levels of between groups (p=0.70). There was one case of chest pain immediately post procedure that was not procedural related. At 6 months, there were no reported cases of death, MI or CHF.
CONCLUSION: Using sensitive CTn assays, a significant rise in TI is seen in virtually all patients undergoing PMI. However this is not associated with an adverse outcome. This should be taken into account when evaluating patients for complications immediately after implant.
Author Disclosures: A. Salacata: None. C. Kaczmierzak: None.
- © 2014 by American Heart Association, Inc.