Detection of myocardial injury during radiofrequency catheter ablation by measuring serum cardiac troponin I levels: procedural correlates

Manolis, Antonis S; Vassilikos, Vassilis; Maounis, Themistoklis; Melita, Helen; Psarros, L.; Haliasos, Alex; Cokkinos, Dennis V.

doi:10.1016/s0735-1097(99)00330-7

Cited by 61 publications

(84 citation statements)

References 21 publications

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“…157 Elevations after ablations are related to the amount of energy used but are usually modest. 161,162 This is also the case for ICD firings and endomyocardial biopsies. There also could be a variety of toxic insults that may exacerbate underlying ischemic heart disease or could function to damage the heart directly.…”

Section: Other Clinical Situations In Which Troponin Levels May Be Elmentioning

confidence: 94%

Troponin: the biomarker of choice for the detection of cardiac injury

Babuin¹

2005

Canadian Medical Association Journal

539

390

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T roponin is the biomarker of choice for the detection of cardiac injury. To use it properly, one must understand how sensitive the specific assay being used is for detecting cardiac injury, the fact that elevated troponin levels are highly specific for cardiac injury and some critical issues related to the basic science of the protein and its measurement. In this article, we review the biology of troponin, characteristics of assays that measure serum troponin levels and how to apply these measurements to patients who present with possible cardiovascular disease. We also discuss other clinical situations in which troponin levels may be elevated. The biology of troponinThe 3-unit troponin complex (troponin I, T and C) along with tropomyosin is located on the actin filament and is essential for the calcium-mediated regulation of skeletal and cardiac muscle contraction. 1 There are tissue-specific isoforms of troponin I, T and C. 2,3 Because the cardiac isoform of troponin C is shared by slow-twitch skeletal muscles, troponin C does not have cardiac specificity and thus is not used in assays for the diagnosis of cardiac injury. 4 There is one cardiac troponin I (cTnI) isoform in myocardial tissue. 5 This isoform has a post-translational tail of 32 amino acids on the N-terminus. 6,7 This sequence and the 42% and 45% dissimilarity with sequences of the other isoforms 8 have made possible the generation of highly specific monoclonal antibodies without cross-reactivity with other noncardiac forms. 9 Three genes control cardiac troponin T (cTnT). 10 These genes and alternative mRNA splicing produce a series of isoforms 10,11 with variable sequences close to the regions of the N-terminus and C-terminus. 10,12 Human cardiac muscle contains 4 troponin T isoforms, but only one is characteristic of the normal adult heart. 13,14 Highly specific antibodies have been made to the N-terminus-specific sequence of this cTnT isoform. 15 The skeletal isoforms present in the fetal heart are replaced by cTnI and cTnT late during fetal development. 16,17 cTnI is not expressed in skeletal muscle or other tissues during development 17 or in response to degenerative or regenerative muscle disease processes. 18 Thus, it is unlikely to be reexpressed in damaged tissues. The situation is more complex for cTnT. Re-expression of fetal forms occurs in cardiac tissue 12 and in diseased skeletal muscle. 19 With the firstgeneration cTnT assay, this problem was compounded by a nonspecific tag antibody that cross-reacted with troponin T in skeletal muscle. 20 Once this antibody was replaced by one with high specificity, false-positive elevations from skeletal muscle were eliminated. 15 Studies using immunohistochemistry and polymerase chain reaction have confirmed that these fetal isoforms are not detected by the assay used today. 21,22 Thus, the assay used to measure cTnT levels has cardiac specificity equivalent to that of assays for cTnI. Characteristics of troponin assaysMost troponin is found in the 3-unit complex (troponin I, T and C) of the c...

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Section: Other Clinical Situations In Which Troponin Levels May Be Elmentioning

confidence: 94%

Troponin: the biomarker of choice for the detection of cardiac injury

Babuin¹

2005

Canadian Medical Association Journal

539

390

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“…A lower cTn level is expected after RF of focal area with few RF lesions. RF ablation of more myocardial tissue in the atria, such as in PV isolation, is expected to have much higher cTn levels [10][11][12][20][21][22][23][24][25]. Previous clinical studies reported contrasting data, in the setting of AF ablation, on cardiac biomarkers levels after cryoballoon ablation compared to RF ablation [7,[13][14][15][16][17][18][19]26].…”

Section: Previous Studiesmentioning

confidence: 99%

“…As several markers have been proven to be useful for diagnosis and evaluation of size of myocardial injury after acute ischemic episode, many authors tried to implement different biomarkers to evaluate and quantify the size of effective ablation lesions [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. On one hand, previous studies have univocally shown humoral biomarkers for myocardial injury to be elevated after radiofrequency (RF) ablation, depending on the amount of energy delivered and the site of ablation [5].…”

Section: Introductionmentioning

confidence: 99%

Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation

Casella

Russo

et al. 2014

Cardiol J

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“…Some studies have shown higher troponin levels after CRYO compared to RF, a finding that suggests CRYO itself causes more myocardial injury and necrosis than RF [17,19]. However, other investigators have found no significant differences between troponin levels after CRYO and RF [7,20]. The contradictory results in previous papers might be explained by the non-randomized design of these studies.…”

Section: Introductionmentioning

confidence: 84%

“…Myocardial injury and cardiac enzyme elevation is common after catheter ablation, a procedure that destroys a small portion of myocardial tissue [9,10,14,20]. Ablation in the ventricles and atrial fibrillation ablations with long linear lesions can result in large necrotic areas and marked cardiac enzyme elevation post procedure [9,11,16,20].…”

Section: Cardiac Injury During Ablationmentioning

confidence: 99%

Myocardial injury during radiofrequency and cryoablation of typical atrial flutter

Saygı

Drca

Insulander

et al. 2015

J Interv Card Electrophysiol

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Detection of myocardial injury during radiofrequency catheter ablation by measuring serum cardiac troponin I levels: procedural correlates

Abstract: The degree of myocardial injury incurred by RFA is far more accurately assessed by cTnI levels rather than by CK-MB measurements. Cardiac troponin I levels correlate with the number of RF lesions applied, the site of RFA and the approach to the mitral annulus.

Cited by 61 publications

References 21 publications

Troponin: the biomarker of choice for the detection of cardiac injury

Troponin: the biomarker of choice for the detection of cardiac injury

Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation

Myocardial injury during radiofrequency and cryoablation of typical atrial flutter

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