title: Troponin elevation after radiofrequency catheter ablation of atrial fibrillation: relevance to AF substrate, procedural outcomes, and reverse structural remodeling.
abstract: BACKGROUND
  Although radiofrequency ablation creates myocardial necrosis leading to troponin T (TnT) release into the systemic circulation, the significance of TnT elevation after atrial fibrillation (AF) ablation is unknown.
  
  
  OBJECTIVE
  To demonstrate a possible mechanism of reverse structural remodeling in the left atrium (LA) by evaluating postprocedural TnT elevation.
  
  
  METHODS
  This study included 106 patients with an enlarged LA (paroxysmal AF, n = 43; persistent AF, n = 63). All patients underwent pulmonary vein isolation alone in the index procedure. Left atrial volume indexed to body surface area (LAVi) was measured by echocardiography before ablation and 6 months after sinus rhythm restoration. Patients were divided into responders (n = 53) and nonresponders (n = 53) based on a cutoff value of 23% reduction in LAVi. The TnT level was measured 12 hours postprocedure.
  
  
  RESULTS
  LAVi decreased from 43 ± 13 to 33 ± 12 mL/m(2) (P < .0001). The TnT level was higher in responders than in nonresponders (1.31 ± 0.34 μg/L vs 0.88 ± 0.29 μg/L; P < .0001) and correlated linearly with percent reduction in LAVi (R = .54; P < .0001). Also in multivariate analysis, the TnT level was the only independent predictor for responders (odds ratio 90.1; 95% confidence interval 14.95-543.3; P < .0001). The TnT level in patients who required a repeat procedure (n = 30) was lower than that in patients who did not require a repeat procedure only in the persistent AF group (0.92 ± 0.38 μg/L vs 1.16 ± 0.37 μg/L; P = .01).
  
  
  CONCLUSIONS
  Greater elevation of the TnT level was related both to favorable outcomes after ablation and to greater reversal of structural remodeling. Postprocedural TnT level may be reflective of the preservation of healthy LA myocardium.
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan. Electronic address: kentaroyo@nifty.com.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yui
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kimata
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Koda
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Jo
authors.initials: J
authors.lastname: Kato
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Baba
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Misaki
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abe
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Tokunaga
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Akishima
authors.affiliation: Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: Division of Cardiovascular Medicine, University of Fukui, Yoshida-gun, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.affiliation: Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.affiliation: Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takeyasu
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology*; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D020107:Troponin T / Q000097:blood*; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D020107:Troponin T
keywords: Atrial fibrillation; Catheter ablation; Reverse remodeling; Structural remodeling; Troponin