Impact of Concomitant Surgical Atrial Fibrillation Ablation on Cardiac Biomarker Release Following Cardiac Surgery

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All articles of this category (opens in new window) Background: The diagnosis of perioperative myocardial infarction (PMI) after cardiac surgery remains challenging, as some degree of myocardial injury is expected. A recently published expert consensus suggested a troponin threshold of > 500 times the upper reference limit (URL) as a criterion for PMI. Surgical ablation for atrial fibrillation (AF) causes additional myocardial injury, potentially leading to further increases in cardiac biomarkers. However, this issue has not been systematically evaluated. We therefore aimed to assess the impact of concomitant AF ablation on postoperative cardiac biomarker release. Methods: We analyzed 377 patients undergoing elective coronary artery bypass grafting (CABG, n = 177), aortic valve replacement (AVR, n = 69), or mitral valve surgery (MVS, n = 131) at our institution. High-sensitivity troponin I (hs-TnI) was measured at baseline (0 hours) and 4, 8, 12, and 24 hours postoperatively. Pulmonary vein isolation (PVI) with bipolar radiofrequency was performed in CABG and AVR patients, while left atrial (LA) cryoablation was performed during MVS. Patients were stratified into ablation and nonablation groups, and analyses were performed separately for each surgical cohort. Results: In the CABG and AVR groups, concomitant epicardial radiofrequency ablation did not result in significant additional hs-TnI release, and median values remained below the 500 URL threshold. In the M vs. cohort, 90 patients underwent surgery alone (Group 1) and 41 underwent concomitant LA cryoablation (Group 2). Group 2 showed significantly higher hs-TnI levels across all time points ( p < 0.001), with median values of 553.1 URL (0 hours), 926.9 URL (4 hours), 676.5 URL (8 hours), 466.5 URL (12 hours), and 223.9 URL (24 hours). hs-TnI levels at 4 and 8 hours exceeded the 500 URL threshold ( p < 0.001 and p = 0.003, respectively). Despite this elevation, the two groups did not differ in need for mechanical circulatory support, inotropic therapy, or 30-day mortality (0% in both groups). Conclusion: Concomitant LA cryoablation during mitral valve surgery was associated with marked hs-TnI elevation, while PVI during CABG or AVR was not. Importantly, hs-TnI levels exceeded the proposed PMI threshold after LA cryoablation without adverse early outcomes. These findings suggest that troponin-based diagnostic criteria for PMI should be interpreted in the context of the underlying surgical procedure and the use of AF ablation. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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