High sensitivity Troponin-T after pulsed field ablation: associations with procedural characteristics and outcome
J Bruss, T Kueffer, H Tanner, F Noti, A Haeberlin, G Thalmann, N Kozhuharov, B Kovacs, V Spahiu, C Herrera Siklody, T Reichlin, L RotenAbstract
Introduction
Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) has been shown to induce a significantly higher increase in high-sensitivity Troponin-T (hs-TnT) compared to radiofrequency and cryoballoon ablation. This retrospective, registry-based analysis aims to investigate associations of hs-TnT increase following PVI using PFA with procedural characteristics and outcome.
Methods
Patients undergoing primary PVI without posterior wall ablation using PFA with a pentaspline PFA catheter between September 2022 and June 2024 enrolled in a prospective registry were included. Laboratory and echocardiographic measurements as well as procedural parameters were collected from chart review. Hs-TnT was measured both prior to and on the day after the procedure. Follow-up included 7-day Holter ECGs at 3, 6, and 12 months, along with data on arrhythmia recurrence from clinical records. Correlation between continuous variables was assessed using Spearman’s correlation coefficients. Comparison between groups was conducted using Wilcoxon’s rank sum test. Covariance was tested using analysis of covariance (ANCOVA). Recurrence-free survival was evaluated using the Mantel-Haenszel Logrank test.
Results
A total of 457 patients were included (median age: 67 years; 69% men). Median hs-TnT levels prior to and following PVI were 10 (7, 15) ng/L and 1581 (1100, 2216) ng/L respectively; the change (Δhs-TnT) was 1547(1078, 2210) ng/L. Patients in the lowest quartile of postinterventional hs-TnT increase had significantly higher recurrence rate at 1 year compared to the remaining patients (Figure 1, p = 0.003). Hs-TnT increase was not correlated with patient age (p 0.967, Figure 2a), eGFR (p 0.066, Figure 2b), the number of PFA applications (p = 0.310, Figure 2c) or operator experience (p = 0.332, Figure 2d). Hs-TnT increased less in patients with persistent AF (p < 0.001, Figure 2e) and correlated negatively with left atrial volume (ρ = -0.374, p < 0.001, Figure 2f) or preinterventional NT-proBNP (ρ = -0.353, p < 0.001, Figure 2g). ANCOVA confirmed the correlation of serum creatinine, LA volume, NT-proBNP and atrial fibrillation type with hs-TnT increase.
Conclusions
Patients with the lowest hs-TnT increase following PFA experienced poorer clinical outcomes. Hs-TnT release was unrelated to operator experience or ablation count, but inversely associated with persistent AF and increased LA volume, both established predictors of AF recurrence. A greater hs-TnT response may be a result of more healthy cardiomyocytes within the ablated area and a healthier atrial substrate, whereas a blunted release may reflect advanced atrial cardiomyopathy with extensive fibrosis and correspondingly poorer outcomes.Figure 1Figure 2