Thorac cardiovasc Surg 1999; 47(3): 157-161
DOI: 10.1055/s-2007-1013132
Original Cardiovascular

© Georg Thieme Verlag Stuttgart · New York

Effects of Defibrillator Implantation Testing on Myocardial Metabolism

U. Wolfhard1 , M. Knocks1 , F. H. Splittgerber1 , S. Sack2 , J. A. Piotrowski1 , M. Günnicker3
  • 1Department of Thoracic and Cardiovascular Surgery
  • 2Department of Cardiology
  • 3Department of Anesthesiology, University of Essen Medical School, Essen, Germany
Further Information

Publication History

1998

Publication Date:
19 March 2008 (online)

Abstract

Background: The effects of fibrillation/defibrillation episodes (FDEs) during defibrillator implantation on myocardial metabolism were investigated at various defibrillation energies in patients with different cardiac pathologies. Methods: Myocardial lactate extraction (MLE) was examined during defibrillation threshold (DFT) testing in patients with either coronary artery disease (CAD, n = 20) or non-ischemic cardiomyopathy (CM, n = 10). Defibrillation pulses were released 15 seconds after induced fibrillation. A test cycle of four FDEs separated by 2-minute intervals was applied in each case. Results: Mean MLE decreased significantly from 28±4% before FDEs to 8 ± 5% immediately after all episodes in CAD patients, but recovered to 27 ± 7% within 2 minutes even in patients with reduced left-ventricular function. In patients with CM mean MLE decreased markedly from 29±3% to -11 ±3% immediately after each FDE but increased to baseline (33 ± 8%) within the recovery period. MLE changes were independent of defibrillation energy in all cases. Conclusions: Myocardial lactate production, suggesting cardiacischemia, was observed in patients with CM, but not in patients with CAD. But recovery of myocardial lactate extraction was not faster in CAD patients, indicating that the fixed FDE cycle used was well tolerated by all patients.