The Role of High-Sensitivity Troponin I in Predicting Atrial High-Rate Episodes (AHREs) in Patients with Permanent...

Area of Science:

• Cardiology
• Biomarkers
• Electrophysiology

Background:

• Atrial high-rate episodes (AHREs) detected by pacemakers are associated with increased stroke risk.
• The predictive role of high-sensitivity cardiac troponin I (hs-cTnI) for AHREs in pacemaker recipients is not well-established.
• This study investigates hs-cTnI as a potential predictor for new AHREs in patients with pacemakers.

Purpose of the Study:

• To evaluate whether baseline hs-cTnI levels can predict the occurrence of new-onset AHREs in patients undergoing permanent pacemaker implantation.
• To compare the predictive value of hs-cTnI against NT-proBNP and traditional risk factors for AHREs.

Main Methods:

• Prospective cohort study including 232 patients (mean age 63.7 years) without pre-existing atrial fibrillation, who received a permanent pacemaker.
• Baseline measurements of hs-cTnI and NT-proBNP were performed.
• Patients were followed for a median of 12 months, with new-onset AHREs (>175 bpm) detected via device interrogation as the primary endpoint.

Main Results:

• New-onset AHREs were observed in 65 (28.0%) patients during the follow-up period.
• Baseline hs-cTnI levels were not significantly different between patients who developed AHREs and those who did not (median 16.5 vs. 15.7 pg/mL, p=0.148).
• Multivariable analysis identified Sick Sinus Syndrome (HR 2.10), heart failure (HR 1.78), and Left Atrial Diameter (HR 1.15) as significant independent predictors of AHREs, while hs-cTnI and NT-proBNP were not.

Conclusions:

• Baseline hs-cTnI and NT-proBNP are not effective predictors of short-term new-onset AHREs in this high-risk pacemaker population.
• Existing electrical and structural cardiac conditions are the primary determinants of arrhythmia development in pacemaker patients.
• Further research may explore other biomarkers or refine risk stratification strategies for AHREs.