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

Background: Atrial high-rate episodes (AHRE), a form of subclinical atrial fibrillation detected by pacemakers, are linked to increased stroke risk. While NT-proBNP is a known predictor of atrial fibrillation, the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) for AHRE in patients with permanent pacemakers remains uncertain. This study evaluated baseline hs-cTnI as a predictor for new-onset AHRE in this specific population. Methods: This prospective cohort study at Cho Ray Hospital enrolled 232 patients (mean age 63.7 years; 53.4% male) without pre-existing atrial fibrillation who were undergoing permanent pacemaker implantation. Baseline hs-cTnI and NT-proBNP were collected pre-procedure. The primary endpoint was the first detection of new-onset AHRE (atrial rate ~175–220 bpm) by device interrogation. Patients were followed for a median of 12.0 months. Results: During follow-up, 65 of 232 patients (28.0%) developed new-onset AHRE. However, baseline hs-cTnI levels were not significantly different between patients who developed AHRE and those who did not (median 16.5 vs. 15.7 pg/mL, p = 0.148). A Kaplan-Meier analysis stratified by hs-cTnI quartiles confirmed no significant difference in AHRE incidence (p = 0.9). Similarly, baseline NT-proBNP levels were not predictive of AHRE (p = 0.396). Conclusion: In this cohort of patients receiving permanent pacemakers, baseline hs-cTnI and NT-proBNP did not predict the development of new-onset subclinical AHRE over a 12-month period. These findings suggest the predictive value of these biomarkers may not be generalizable to this high-risk cohort for short-term arrhythmia risk.