Use of troponin-T concentration and kinase isoforms for quantitation of myocardial injury induced by radiofrequency catheter ablation

Abstract

Background Although there remains particular concern about late malignant ventricular arrhythmias arising from myocardial damage induced by catheter ablation, the extent of myocardial injury resulting from clinical ablation procedures has not been fully studied. We conducted a prospective, controlled study to investigate the use of two newer markers of myocardial integrity, troponin-T concentration and creatine kinase isoforms, and a traditional marker, creatine kinase-MB concentration, in the assessment of myocardial injury following radiofrequency catheter ablation. Methods and resultsThe study population consisted of 28 consecutive patients subjected to radiofrequency catheter ablation, and the control group comprised eight subjects undergoing diagnostic electrophysiology study. Prior to ablation and at 30 min, 1, 2, 6, and 12 h following the procedure, blood samples were taken to measure troponin-T and creatine kinase-MB concentrations, and the separation of creatine kinase isoforms (MM3/MM1 and MB2/MB1 ratios). The troponin-T concentration was above normal in all but two patients following radiofrequency ablation, and the MB2/MB1 ratio was raised in all but one patient following ablation, but was also abnormal in the pre-ablation samples in seven patients. The MM3/MM1 ratio failed to detect myocardial injury in 75% of patients. Of patients subjected to ablation, in only 36% was the creatine kinase-MB concentration raised at least once post-ablation. Thirty minutes post-ablation, there was a statistically significant difference between the control and patient groups only as regards troponin-T concentration. There was a significant association between troponin-T concentration immediately post-procedure, the number of discharges delivered (r=0-52, / > =0006) and maximum power used (r=0-48, P=0009). ConclusionOur results indicate that catheter ablation inflicts a cumulative, detectable injury upon the myocardium. This injury can be quantitated by using newer analytical techniques, such as serial, post-ablation measurements of troponin-T concentration.

Time Course of Inflammation, Myocardial Injury, and Prothrombotic Response After Radiofrequency Catheter Ablation for Atrial Fibrillation

“…Other studies on mixed cohorts of patients undergoing RF ablation have found a peak in markers of myocardial injury within the first few hours after ablation. 5,13 The findings of RF ablation time being an independent predictor of Troponin-T elevation, consistent with previous studies, 5,13 and higher extent of Troponin-T elevation in patients with persistent AF suggest that markers for myocardial injury relate to the extent of ablation, with more extensive ablation performed in patients with persistent forms of AF.…”

“…3 Radiofrequency (RF) ablation for atrial arrhythmias is known to cause an increase in various markers of inflammation and myocardial injury. 4,5 Moreover, biomarker detection of myocardial injury is a key component in the third universal definition of myocardial infarction, and ablation is known to be a confounder. 6 A protracted elevation of CRP is seen after AF ablation and, after successful ablation of long-lasting persistent AF, a decline in CRP at 3 months is observed.…”

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

“…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.…”

Evaluation of post-radiofrequency myocardial injury by measuring cardiac troponin I levels

“…The cardiac isotype is specific for heart muscle injury. However, it has rarely been [3][4][5][6][7][8][9]. Cardiac troponin I (cTnI) has been shown to be more sensitive and specific than CK-MB and more specific than cardiac troponin T for the diagnosis of minor myocardial injury [10][11][12].…”