Abstract and Introduction
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, CHA2DS2-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.
Atrial fibrillation (AF) is a common cardiac arrhythmia and is associated with increased mortality and morbidity.[1,2] Some clinical studies have reported that catheter ablation reduces AF recurrence and improves the quality of life better than antiarrhythmic drugs.[3,4] In recent propensity score-matched population-based studies, the incidence of stroke and mortality was significantly lower in the ablation group than in the nonablation group.[5,6] However, risk stratification tools are needed in the decision making about oral coagulants and medical treatments for individual patients after AF ablation. Previous studies reported that the CHA2DS2-VASc score was useful in identifying patients with AF at a high risk of stroke, myocardial infarction, and cardiac mortality.[7–9] Moreover, the CHA2DS2-VASc score was also reported to be an excellent tool in stratifying patients in terms of clinical outcomes such as AF recurrence, stroke, heart failure, and death after AF ablation.
High-sensitive troponin T (hs-TnT) is a biochemical marker of myocardial damage. The ARISTOTLE Investigators reported that an elevated hs-TnT level was independently associated with an increased risk of stroke, cardiac death, and major bleeding in patients with AF and that hs-TnT improved the risk stratification beyond the CHA2DS2-VASc score. However, the prognostic value of hs-TnT after AF ablation was unknown. The purpose of this study was to evaluate the utility of hs-TnT for predicting AF recurrence and major adverse cardiovascular events (MACE) after AF ablation.
J Cardiovasc Electrophysiol. 2019;30(9):1475-1482. © 2019 Blackwell Publishing