Prognostic value of high‐sensitive troponin T for predicting cardiovascular events after atrial fibrillation ablation

Q: What does this research mean for the field?

High-sensitive troponin T levels greater than or equal to 0.014 µg/L independently predict atrial fibrillation recurrence and major adverse cardiovascular events following atrial fibrillation ablation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shota Tamura; Atsushi Doi; Masanori Matsuo; Hisashi Katayama; Tomotaka Yoshiyama; Hiroaki Tatsumi; Yasuhiro Izumiya; Minoru Yoshiyama

doi:10.1111/jce.14032

June 13, 2019Journal of Cardiovascular Electrophysiology

Prognostic value of high‐sensitive troponin T for predicting cardiovascular events after atrial fibrillation ablation

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Why the study?

The study aimed to evaluate the utility of high-sensitive troponin T for predicting AF recurrence and major adverse cardiovascular events after AF ablation.

Does pre-ablation high-sensitive troponin T level predict AF recurrence or MACE in patients undergoing initial AF ablation?

Structured PICO

Does pre-ablation high-sensitive troponin T level predict AF recurrence or MACE in patients undergoing initial AF ablation?

P

Population

227 consecutive patients with atrial fibrillation (mean age 66 ± 10 years; 98 with persistent AF) undergoing an initial ablation

I

Intervention

High pre-ablation high-sensitive troponin T (hs-TnT) level (≥0.014 µg/L)

C

Comparator

Low (≤0.005 µg/L) or medium (0.006–0.013 µg/L) pre-ablation hs-TnT levels

O

Outcome

Composite endpoint of AF recurrence or MACE (including death, stroke, acute coronary syndrome, and heart failure hospitalization) after ablationcomposite

Pre-ablation high-sensitive troponin T levels ≥0.014 µg/L independently predict AF recurrence and major adverse cardiovascular events following initial atrial fibrillation ablation.

Implication

Elevated pre-ablation hs-TnT may support risk stratification in AF ablation; hypothesis-generating and requires prospective validation before guiding practice.

Abstract

Background and Objectives This study aimed to evaluate the utility of high‐sensitive troponin T (hs‐TnT) for predicting AF recurrence and major adverse cardiovascular events (MACE) after AF ablation. Methods and Results A total of 227 consecutive patients with AF (mean age, 66 ± 10 years; persistent AF, n = 98) who underwent an initial ablation were enrolled. We measured hs‐TnT before AF ablation and divided the patients into three groups according to the hs‐TnT level: low, lesser than or equal to 0.005 µg/L (n = 54); medium, 0.006–0.013 µg/L (n = 127); and high, greater than or equal to0.014 µg/L (n = 46). We evaluated the composite endpoint of AF recurrence or MACE (including death, stroke, acute coronary syndrome, and heart failure hospitalization) after the ablation. The median hs‐TnT level was 0.008 µg/L. The values of chronic kidney disease prevalence, CHA 2 DS 2 ‐VASc score, B‐type natriuretic peptide level, and left atrial diameter were the highest in the high hs‐TnT group among the three groups. During a mean follow‐up of 15 ± 8 months, AF recurrence and MACE occurred in 56 (25%) and 9 (4%) patients, respectively. The high hs‐TnT group had the highest incidence of AF recurrence and MACE among the three groups (high: 39% and 15%, medium: 22% and 2%, and low: 19% and 0%, respectively; log‐rank P < .05). In multivariate analysis, hs‐TnT greater than or equal to 0.014 µg/L and persistent AF were independent predictors of the composite endpoint. Conclusion Hs‐TnT may be a useful marker for predicting AF recurrence or MACE after AF ablation.