Prediction of mid-term outcome after cryo-balloon ablation of atrial fibrillation using post-procedure high-sensitivity troponin level

Abstract

ObjectiveHigh-sensitivity troponin I (hsTnI) assays lead to, among other things, improvement in the detection of myocardial injury and improved risk stratification of patients with atrial fibrillation (AF). The aim of this study was to investigate the association between post-procedure cardiac biomarkers and clinical outcome in patients undergoing cryo-balloon ablation (CA) for AF.MethodsA total of 57 patients (mean age 55.1 ± 12.2 years, 50.9% female) with symptomatic paroxysmal AF underwent the CA procedure. Two hundred and twenty-eight pulmonary veins (PVs) were attempted for pulmonary vein isolation (PVI) with a second-generation cryo-balloon. hsTnI, CK-MB mass and myoglobin samples were prospectively obtained before and 24 hours after ablation.ResultAt a mean follow up of 214.6 ± 24.3 days, the probability of being arrhythmia free after a single procedure was 86%. Post-ablation hsTnI (p = 0.001), left atrial (LA) diameter (p = 0.002), duration of AF (p = 0.002), mean minimal temperature of the left superior pulmonary vein (p = 0.005), and age (p = 0.021) were associated with increased AF recurrence rate. On multivariate analysis, lower hsTnI level was the only independent predictor for AF recurrence (p = 0.012). Post-ablation hsTnI levels lower than 4.40 ng/ml predicted AF recurrence during follow up, with a sensitivity of 86% and a specificity of 96%.ConclusionIt is well recognised that the PV antrum contributes to initiation and/or perpetuation of AF. A lower postablation hsTnI level may predict an increased AF recurrence rate, suggesting inadequate ablation of the PV antrum. This may be used as a non-invasive marker to predict the outcome of AF.

Comparison of myocardial injury and inflammation after pulmonary vein isolation for paroxysmal atrial fibrillation between radiofrequency catheter ablation and cryoballoon ablation

“…This study included 25 patients using RFA and 50 patients with CBA and a small number of cases might be obtained different results. Another report demonstrated that a lower postablation hs‐TnI level may predict an increased AF recurrence rate 20 . In this study, 57 patients using CBA were included and LRAF patients showed lower hs‐TnI level.…”

Functional mitral regurgitation

“…[19–21] Among them, MR was demonstrated to have a detrimental impact on AF ablation outcomes. [5] Moreover, the grade of MR severity had positive correlation with the recurrence rate.…”

High-Sensitivity Troponin I and Rhythm Outcome after Electrical Cardioversion for Persistent Atrial Fibrillation

“…Furthermore, cardiac troponins have been associated with new-onset AF in patients admitted to hospital with acute ischaemic stroke [24] and also with incident AF in community-based cohorts [1,2,3]. On the other hand, the evidence of any predictive abilities of cardiac troponins in rhythm outcome after electrical cardioversion is scarce, and the results regarding ablation outcome are conflicting [25,26]. Considering that no survival advantage has been shown from a rhythm control strategy in AF [27], one should perhaps not expect predictors of recurrence and mortality in AF to overlap.…”