Assessment of the Extent of Myocardial Injury in Patients Undergoing Transvenous Implantation of a Pacemaker Using Cardiac Troponin I as a Marker of Structural Heart Damage and Its Relation to Different Sites of RV Implantation

Background and Aim: This study aimed to evaluate the degree of myocardial injury that occurs after transvenous pacemaker implantation using cardiac troponin I (cTnI) as a myocardial injury marker and the relationship between the number of screws, different sites of right ventricle (RV) lead implantation, and myocardial injury. Materials and Methods: Fifty patients at Ain Shams University Hospitals who underwent transvenous implantation of single- or dual-chamber permanent pacemakers were included in the study. According to the site of RV lead implantation, the study population was divided into 2 equal groups, 25 patients each. In the first group, the RV lead was implanted in the RV apex and in the other group, the RV lead was implanted in the RV septum. Results: In all patients, the cTnI level was elevated after pacemaker implantation, showing a significant relationship between transvenous pacemaker implantation and the incidence of myocardial injury. Comparing the RV apical pacing group with the RV septal pacing group, a greater rise in cTnI was recognized in the septal RV pacing group, indicating a significant relationship between the site of RV lead implantation and the degree of myocardial injury being more in the RV septum than in the RV apex. Moreover, the higher the number of attempts of screwing the lead in different RV sites caused more rise in cTnI, denoting a significant relationship between the number of screwing attempts and the extent of myocardial injury. Conclusion: Transvenous pacemaker implantation is associated with an increased incidence of myocardial injury, and septal RV lead implantation is associated with a higher degree of myocardial injury than apical RV lead implantation. In addition, a higher number of screwing attempts of the RV lead into the myocardium is associated with a higher degree of myocardial injury