Background

Conflicting results have been reported regarding the prognostic value of high-sensitive troponin T (TnT) for predicting the recurrence of atrial arrhythmias (AA) after radiofrequency catheter ablation (RFA) for atrial fibrillation (AF). Especially, data regarding the increase of TnT levels after RFA and the recurrence of AA are lacking. The aim of this study was to assess the association between increase of TnT levels after RFA for persistent AF and the recurrence of AA.

Methods

Patients who underwent RFA for persistent AF at the German Heart Centre Munich and provided written informed consent were included in the study during the time-period June 2020 until April 2021. RFA was performed as pulmonary vein isolation (PVI, high-power short-duration) with or without additional ablations, e.g. complex fractionated atrial electrograms (CFAE) ablations. TnT was measured the day before RFA and the day after. Delta TnT was calculated from these values.

Results

Altogether, 64 patients (18.8% female, mean age 65.4 ± 9.1 years) with persistent AF were included. Out of these 32 patients (50.0%) underwent a PVI, while 32 (50.0%) received additional ablations. Delta TnT was higher in the latter group compared to the PVI only group (1972 ± 1198 ng/l vs. 1215 ± 426 ng/l, p=0.005). Additionally, RF time was also longer in the group with additional ablations (29.7 ± 9.6 min vs. 16.7 ± 5.7 min, p<0.001). After a median follow-up duration of 47 days (IQR 35-111), 40% of patients were still in sinus rhythm without any recurrence of AA. On univariate analysis, delta TnT, coronary artery disease as well as RF time were predictors of freedom from recurrence of AA, while baseline TnT was not. In the multivariate analysis, only delta TnT remained in the model and was a predictor for maintenance of sinus rhythm during follow-up (HR: 1.0008, 95% CI: 1.0002–1.0015, p = 0.0016).

Conclusions

Additional ablations (e.g. CFAE ablation) in addition to PVI are associated with longer RF time and higher delta TnT. However, only delta TnT is a predictor for freedom of recurrence of AA after RFA for persistent AF. The results of this study need to be further analysed and confirmed in larger cohorts.