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Original research article
High-sensitive cardiac troponin T as a predictor of efficacy and safety after pulmonary vein isolation using focal radiofrequency, multielectrode radiofrequency and cryoballoon ablation catheter
  1. Ivan Zeljkovic1,
  2. Sven Knecht1,
  3. Nikola Pavlovic2,
  4. Umut Celikyrut3,
  5. Florian Spies1,
  6. Sarah Burri1,
  7. Dominik Mannhart1,
  8. Loris Peterhans1,
  9. Tobias Reichlin1,
  10. Beat Schaer1,
  11. Stefan Osswald1,
  12. Christian Sticherling1 and
  13. Michael Kuhne1
  1. 1Cardiology, University Hospital Basel, Basel, Switzerland
  2. 2Cardiology, Klinicki bolnicki centar Sestre milosrdnice, Zagreb, Croatia
  3. 3Cardiology, Kocaeli Universitesi, Kocaeli, Turkey
  1. Correspondence to Dr Ivan Zeljkovic; ivanzeljkov{at}gmail.com

Abstract

Introduction Myocardial injury markers such as high-sensitive cardiac troponin T (hs-cTnT) and creatine kinase MB (CK-MB) reflects the amount of myocardial injury with ablation. The aim of the study was to identify the value of myocardial injury markers to predict outcomes after pulmonary vein isolation (PVI) using three different ablation technologies.

Methods Consecutive patients undergoing PVI using a standard 3.5 mm irrigated-tip radiofrequency catheter (RF-group), an irrigated multielectrode radiofrequency catheter (IMEA-group) and a second-generation cryoballoon (CB-group) were analysed. Blood samples to measure injury markers were taken before and 18–24 hours after the ablation. Procedural complications were collected and standardised follow-up was performed. Logistic regression was used to identify predictors of recurrence and complications.

Results 96 patients (RF group: n=40, IMEA-group: n=17, CB-group: n=39) undergoing PVI only were analysed (82% male, age 59±10 years). After a follow-up of 12 months, atrial fibrillation (AF) recurred in 45% in the RF-group, 29% in the IMEA-group and 36% in the CB-group (p=0.492). Symptomatic pericarditis was observed in 20% of patients in the RF-group, 15% in the IMEA-group and 5% in the CB-group (p=0.131). None of the injury markers was predictive of AF recurrence or PV reconnection after a single procedure. However, hs-cTnT was identified as a predictor of symptomatic pericarditis (OR: 1.003 [1.001 to 1.005], p=0.015).

Conclusion Hs-cTnT and CK-MB were significantly elevated after PVI, irrespective of the ablation technology used. None of the myocardial injury markers were predictive for AF recurrence or PV reconnection, but hs-cTnT release predicts the occurrence of symptomatic pericarditis after PVI.

  • radiofrequency
  • cryoballoon
  • nmarq
  • ablation
  • atrial fibrillation
  • pulmonary vein isolation
  • high-sensitive-troponin T
  • creatine kinase-mb
  • creatine kinase
  • recurrence
  • complications
  • pericarditis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • IZ and SK are joint first authors.

  • Contributors IZ, SK, NP: concept/design, data analysis/interpretation, drafting article, critical revision of article, approval of article. SK: concept/design, data analysis/interpretation, drafting article, critical revision of article, approval of article, statistics. NP: concept/design, data analysis/interpretation, drafting article, critical revision of article, approval of article, data collection. UC: data collection, data analysis/interpretation, drafting article, approval of article. FS, SB, DM, LP, TR, BAS, SO, CS, MK: data analysis/interpretation, critical revision of article, approval of article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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