Relationship of troponin to incident atrial fibrillation occurrence, recurrence after radiofrequency ablation and prognosis: a systematic review, meta-analysis and meta-regression

Objective: To explore the association between the levels of troponin (Tn) and incident atrial fibrillation (AF) occurrence, AF recurrence after radiofrequency ablation (RFA), and the risk trend of AF related prognosis (stroke, major bleeding and mortality).Methods: Twenty-seven studies were included after a systematic search in PubMed from 2005 to 2017, including 13 associated with incident AF occurrence, 8 associated with AF recurrence after RFA and 6 studies evaluating the risk trend of AF-related prognosis with increased Tn levels.Results: Compared with ‘no incident AF occurrence’ patients, the incident AF occurrence group had similar baseline troponin I (TnI) levels (standardized mean differences [SMD] = 0.42, 95% CI: −0.02–0.86, p = 0.06; I2 = 87.0%, N = 6), but higher troponin T (TnT) levels (SMD = 3.77, 2.13–5.42, p <0.001; I2=99.7%, N = 8). AF recurrence patients had similar peri-ablation TnI levels, but higher peri-ablation TnT levels compared to the ‘no AF recurrence’ group with pooled SMD. (TnI: SMD: −0.61, −1.22to 0, p = 0.049; I2 = 87.1%; TnT: 0.38, 0.14–0.62, p = 0.002; I2 = 64.7%). On meta-regression, there was an increased risk trend for stroke/systemic embolism (SE) (r2 = 0.93, p = 0.04) or major bleeding (r2 = 0.99, p < .0001) with the increasing TnT levels. Mortality was not significantly related to TnI (r2 = 0.09, p = 0.25) or TnT (r2 = 0.20, p = 0.31), and stroke/SE (r2 = 0.02, p = 0.74) or major bleeding (r2 = 0.002, p = 0.92) was non-significantly related to increasing TnI levels.Conclusions: In our systematic review, meta-analysis and meta-regression, TnT was associated with both incident AF occurrence and AF recurrence after RFA, as well as stroke/SE and major bleeding. In contrast, TnI was not associated with incident AF occurrence, AF recurrence after RFA or prognosis (stroke/SE, major bleeding).