Threshold energy dose for enzyme release after direct-current countershock
International Journal of Cardiology(1996)
摘要
Serial measurement of serum total creatine kinase and creatine kinase MB isoenzyme was prospectively performed by photometric assay in 82 consecutive patients (55 male and 27 female; mean age 62 ± 11 years) after elective DC countershock for atrial flutter or fibrillation. Enzyme release is commonly observed to follow DC shock; the related energy threshold for enzyme release, however, a parameter with potential clinical usefulness, has not yet been determined. The energy dose was individually titrated but the anterolateral paddle-electrode location was used in all cases. The mean ± S.D. (range) of shock number, peak energy level and cumulative energy dose normalized to body weight were respectively: 1.7 ± 0.9 (1–5), 228.6 ± 87.6 (75–400) J and 5.26 ± 3.74 (1.0–19.7) J/kg. All these parameters had highly significant positive correlation with enzyme release (P < 0.0001), which peaked 16 h after countershock. Only creatine kinase levels changed significantly vs. baseline (P < 0.0001). As evidenced by dose vs. effect scattergram, the energy threshold value for enzyme release was around 4 J/kg for creatine kinase and 6 J/kg for creatine kinase MB isoenzyme. These energy dose figures may provide clinical usefulness to avoid unnecessary muscle damage; moreover, they may be used as a reference when enzyme elevations interfere with the diagnosis of a concomitant ischemic acute myocardial infarction.
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关键词
Cardioversion,Creatine kinase,Creatine kinase MB isoenzyme,Direct-current countershock
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