Comparison between Internal and External Cardioversion during Ablation for Atrial Fibrillation in Myocardial Damage Measured by Cardiac Enzyme

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Background: Atrial defibrillation during catheter ablation may cause myocardial damage. The aim of this study was to compare the extent of myocardial injury caused by intracardiac shocks with extracardiac shocks during ablation. Methods: CPK, CK-MB and Troponin I were measured before and after ablation. Number of times and total electric energy were recorded. Patients were divided into 3 groups, non cardioversion (NC) group, external cardioversion (EC) group and internal cardioversion (IC) group. Results 62 consecutive patients were studied and 46 patients received electrical cardioversion, 34 were externally and 11 were internally. The number of cardioversion was 3.9 in EC group, and 4.2 in IC group (P=NS). Total shock energy was 358 joule in EC group and 21.8 joule in IC group (P=0.007). Total ablation time of NC, EC, and IC group was 2970 sec, 2605 sec and 3128 sec respectively (P=NS). There was no significant difference between NC, EC, and IC group in post-CPK (148 IU/l, 203 IU/l and 182 IU/l respectively, P=NS), in post-CPK-MB (16.1 IU/l, 14.2 IU/l and 15.7 IU/l respectively, P=NS), in post-troponin I (3.2 ng/ml, 3.6 ng/ml and 3.5 ng/ml respectively, P=NS). Post-troponin I correlated with ablation time (r=0.2, P=0.003) Conclusion: There was no difference between the myocardial damage caused by internal and external cardioversion.