Europace Advance Access published online on January 3, 2008
Europace, doi:10.1093/europace/eum273
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Cardiac injury after percutaneous catheter ablation for atrial fibrillation
Department of Cardiology, Royal Jubilee Hospital, 1952 Bay Street, Victoria, B.C., Canada V8R 1J8
Aims: Small elevations in troponin T levels have been shown with limited radiofrequency (RF) ablation procedures for supraventricular tachycardia, usually to levels below the threshold for ischaemia or infarction. Left atrial catheter ablation for atrial fibrillation (AF) requires far more RF energy, therefore could be expected to have greater elevation in troponin T. We determined troponin T levels before and after ablation in these patients to evaluate the amount of rise with this ablation.
Methods: All patients undergoing pulmonary vein isolation (PVI) from May 2004 to October 2004 had troponin T levels measured 4 h following completion of the procedure. The first 30 patients also had a troponin T level measured 1 h prior to PVI to establish a baseline reference.
Results: Sixty patients were studied, with 81.7% males and a mean age of 54.6 ± 9.9 years. No patient had underlying structural heart disease. The baseline troponin T level was normal (<0.01 µg/L) in all 30 patients. Post-procedure troponin T levels were elevated in all 60 patients compared with baseline (P < 0.05), with a mean level of 0.85 µg/L and a range of 0.26–1.57 µg/L after an average RF ablation time of 56 ± 15 min. All levels were above the reference range for diagnosis of acute myocardial infarction (>0.15 µg/L). Troponin T level was not related to the number of RF lesions, RF time, procedure time, or associated external cardioversion.
Conclusions: Troponin T elevations occurred in all patients undergoing PVI, to levels at least 20 times the normal concentration, into the range for diagnosis of acute myocardial infarction. Therefore, troponin T would not be specific for ischaemia in the setting of chest pain post-catheter ablation for AF.
Key Words: Atrial fibrillation, Troponin T, Radiofrequency ablation, Myocardial necrosis
* Corresponding author. Department of Cardiology, Western Cardiology Associates, 335-1900 Richmond Ave, Victoria, BC, Canada, V8R 4R2. Tel: +1 250 370 8246; fax: +1 250 370 8726. E-mail address: pgnovak{at}shaw.ca
Manuscript submitted 4 September 2007. Accepted after revision 19 November 2007.