Can cardiac ablation (catheter ablation) cause an increase in troponin levels, indicating cardiac muscle damage?

From the Guidelines

Ablation procedures can indeed cause an increase in troponin levels, as they involve deliberate damage to heart tissue, leading to the release of troponin into the bloodstream. According to the most recent evidence from 1, cardiac ablation is listed as a cause of cardiac troponin elevation due to myocardial injury not related to myocardial ischemia. The study highlights that troponin elevation can occur due to various factors, including cardiac contusion, surgery, ablation, pacing, or defibrillator shocks.

The mechanism of troponin elevation after ablation is related to the intentional injury caused to the cardiac tissue, which results in the release of troponin into the bloodstream. The degree of troponin increase generally correlates with the extent of ablation performed, with more extensive procedures causing higher troponin levels. For example, atrial fibrillation ablation, which requires more extensive tissue modification, typically causes greater troponin elevation than simpler ablation procedures.

Key points to consider when interpreting troponin levels after ablation include:

• Troponin elevation is a normal and expected finding after ablation
• The degree of troponin increase correlates with the extent of ablation performed
• Troponin levels usually peak within 24 hours after the procedure and gradually return to baseline over several days
• Troponin release occurs due to cardiac cell injury, which represents the intended therapeutic effect rather than a complication in this specific context

It is essential to note that the diagnosis of myocardial infarction requires a rise and/or fall in troponin values, with at least one value above the decision level, coupled with a strong pre-test likelihood, as stated in 1. However, in the context of ablation, troponin elevation is expected and does not necessarily indicate a complication.

From the Research

Ablation and Troponin Levels

• Ablation procedures can cause an increase in troponin levels, as shown in several studies 2, 3, 4, 5, 6.
• The degree of troponin elevation can vary depending on the type of ablation procedure, with ventricular ablations tend to cause higher troponin levels than atrial ablations 4.
• The number of radiofrequency lesions applied and the duration of the ablation procedure can also impact the level of troponin elevation 3, 6.
• High-sensitivity troponin T (hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) are sensitive markers for detecting myocardial injury after ablation procedures 4, 6.

Types of Ablation Procedures

• Radiofrequency ablation (RFA) for atrial fibrillation can cause significant elevations in troponin T levels, with mean levels ranging from 0.85 to 2.19 microg/L 2, 3.
• RFA for ventricular tachycardia can also cause troponin elevations, with higher levels observed in ventricular ablations compared to atrial ablations 4.
• Ablation procedures for other types of arrhythmias, such as atrioventricular nodal re-entry tachycardia (AVNRT) and right atrial flutter (AFL), can also cause troponin elevations 6.

Clinical Implications

• The elevation of troponin levels after ablation procedures can make it difficult to diagnose acute coronary syndrome in the post-procedure period 5.
• Therefore, it is essential to consider the type of ablation procedure and the expected troponin elevation when interpreting troponin levels in patients who have undergone ablation procedures 5.