{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T13:08:07Z","timestamp":1764680887688,"version":"3.46.0"},"reference-count":33,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Atrial high-rate episodes (AHREs) detected by pacemakers are linked to increased stroke risk. The predictive value of high-sensitivity cardiac troponin I (hs-cTnI) for AHREs in pacemaker patients remains uncertain. This study evaluated baseline hs-cTnI as a predictor for new-onset AHREs in this population. Methods: This prospective cohort study enrolled 272 patients undergoing permanent pacemaker implantation. We excluded 40 patients with pre-existing atrial fibrillation (AF), leaving a total of 232 patients (mean age 63.7 years; 53.4% male) in the at-risk cohort. Baseline hs-cTnI and NT-proBNP were measured. The primary endpoint was new-onset AHREs (&gt;175 bpm), detected by device interrogation over a median follow-up of 12 months. Results: New-onset AHREs occurred in 65 (28.0%) patients. Contrary to our hypothesis, baseline hs-cTnI levels did not differ significantly between patients who developed AHREs and those who did not (median 16.5 vs. 15.7 pg\/mL, p = 0.148). Multivariable Cox regression confirmed that neither hs-cTnI nor NT-proBNP were independent predictors. Instead, Sick Sinus Syndrome (HR 2.10, p &lt; 0.001), heart failure (HR 1.78, p = 0.010), and Left Atrial Diameter (HR 1.15, p = 0.006) were significant independent predictors. Conclusions: In this high-risk pacemaker cohort, baseline hs-cTnI and NT-proBNP did not predict short-term new-onset AHREs. Established electrical and structural substrates appear to be the overwhelming drivers of arrhythmia in this specific population.<\/jats:p>","DOI":"10.3390\/life15121850","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:39:43Z","timestamp":1764679183000},"page":"1850","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of High-Sensitivity Troponin I in Predicting Atrial High-Rate Episodes (AHREs) in Patients with Permanent Pacemakers"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2838-4806","authenticated-orcid":false,"given":"Linh Ha Khanh","family":"Duong","sequence":"first","affiliation":[{"name":"Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nien Vinh","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1538-7917","authenticated-orcid":false,"given":"Vinh Thanh","family":"Tran","sequence":"additional","affiliation":[{"name":"Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1038\/s41572-022-00347-9","article-title":"Atrial fibrillation","volume":"8","author":"Brundel","year":"2022","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/1747493019897870","article-title":"Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge","volume":"16","author":"Lippi","year":"2021","journal-title":"Int. J. Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100786","DOI":"10.1016\/j.lanepe.2023.100786","article-title":"Atrial fibrillation: Epidemiology, screening and digital health","volume":"37","author":"Linz","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Svennberg, E., Freedman, B., Andrade, J.G., Anselmino, M., Biton, Y., Boriani, G., Brandes, A., Buckley, C.M., Cameron, A., and Clua-Espuny, J.L. (2025). Recent-onset atrial fibrillation: Challenges and opportunities. Eur. Heart J., ehaf478.","DOI":"10.1093\/eurheartj\/ehaf478"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"i162","DOI":"10.1093\/eurheartjsupp\/suae088","article-title":"Subclinical atrial fibrillation\/atrial high-rate episodes: What significance and decision-making?","volume":"27","author":"Boriani","year":"2025","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Aletras, G., Koutalas, E., Bachlitzanaki, M., Stratinaki, M., Bachlitzanaki, I., Stavratis, S., Garidas, G., Pitarokoilis, M., and Foukarakis, E. (2025). Paroxysmal Supraventricular Tachycardia and Troponin Elevation: Insights into Mechanisms, Risk Factors, and Outcomes. J. Clin. Med., 14.","DOI":"10.3390\/jcm14165644"},{"key":"ref_7","unstructured":"Orozco-Burbano, J.D., Chara-Salazar, C.J., Vargas-Zabala, D.L., Castillo-Concha, J.S., Agudelo-Uribe, J.F., and Ramirez-Barrera, J.D. (2025). Clinical relevance and management of atrial high-rate episodes: A narrative review. Arch. Cardiol. Mex., ahead of print."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1056\/NEJMoa1105575","article-title":"Subclinical atrial fibrillation and the risk of stroke","volume":"366","author":"Healey","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5611","DOI":"10.19102\/icrm.2023.14101","article-title":"The Role of Biochemical Cardiac Markers in Atrial Fibrillation","volume":"14","author":"Rafaqat","year":"2023","journal-title":"J. Innov. Card. Rhythm. Manag."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sieweke, J.T., Pfeffer, T.J., Biber, S., Chatterjee, S., Weissenborn, K., Grosse, G.M., Hagemus, J., Derda, A.A., Berliner, D., and Lichtinghagen, R. (2020). miR-21 and NT-proBNP Correlate with Echocardiographic Parameters of Atrial Dysfunction and Predict Atrial Fibrillation. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041118"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e13950","DOI":"10.1111\/eci.13950","article-title":"Risk prediction of atrial fibrillation and its complications in the community using hs troponin I","volume":"53","author":"Borschel","year":"2023","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e944","DOI":"10.1161\/CIR.0000000000000740","article-title":"Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association","volume":"140","author":"Noseworthy","year":"2019","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1136\/heartjnl-2024-324685","article-title":"Association between NT-proBNP levels and risk of atrial fibrillation: A systematic review and meta-analysis of cohort studies","volume":"111","author":"Wang","year":"2025","journal-title":"Heart"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1159\/000258679","article-title":"Troponin levels help predict new-onset atrial fibrillation in ischaemic stroke patients: A retrospective study","volume":"63","author":"Bugnicourt","year":"2010","journal-title":"Eur. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.repc.2020.10.019","article-title":"Clinical value of the combined use of P-wave dispersion and troponin values to predict atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation","volume":"40","author":"Ocak","year":"2021","journal-title":"Rev. Port. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00392-019-01545-4","article-title":"Are atrial high rate episodes (AHREs) a precursor to atrial fibrillation?","volume":"109","author":"Khan","year":"2020","journal-title":"Clin. Res. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s13577-024-01145-z","article-title":"Pathophysiology, molecular mechanisms, and genetics of atrial fibrillation","volume":"38","author":"Han","year":"2024","journal-title":"Hum. Cell"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Antoun, I., Layton, G.R., Nizam, A., Barker, J., Abdelrazik, A., Eldesouky, M., Koya, A., Lau, E.Y.M., Zakkar, M., and Somani, R. (2025). Hypertension and Atrial Fibrillation: Bridging the Gap Between Mechanisms, Risk, and Therapy. Medicina, 61.","DOI":"10.3390\/medicina61020362"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Koniari, I., Bozika, M., Nastouli, K.M., Tzegka, D., Apostolos, A., Velissaris, D., Leventopoulos, G., Perperis, A., Kounis, N.G., and Tsigkas, G. (2025). The Role of Early Risk Factor Modification and Ablation in Atrial Fibrillation Substrate Remodeling Prevention. Biomedicines, 13.","DOI":"10.3390\/biomedicines13020405"},{"key":"ref_21","unstructured":"Parajuli, P., Alahmadi, M.H., and Ahmed, A.A. (2025). Left Atrial Enlargement. StatPearls, StatPearls Publishing."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ma, J.F., Hu, J., Fu, H.X., Zhou, Y., Chen, M., Zhang, P.P., Yu, Y.C., Wang, Q.S., Sun, J., and Li, Y.G. (2025). The risk factors of atrial substrate remodeling in the patients of paroxysmal atrial fibrillation following pulmonary vein isolation. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-04809-2"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Saadeh, R., Abu Jaber, B., Alzuqaili, T., Ghura, S., Al-Ajlouny, T., and Saadeh, A.M. (2024). The relationship of atrial fibrillation with left atrial size in patients with essential hypertension. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-51875-1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70009","DOI":"10.1002\/joa3.70009","article-title":"Mid-term comparison of new-onset AHRE between His bundle and left bundle branch area pacing in patients with AV block","volume":"41","author":"Pestrea","year":"2025","journal-title":"J. Arrhythm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.21037\/qims-23-1237","article-title":"Study on the relationship between atrial high-rate episode and left atrial strain in patients with cardiac implantable electronic device","volume":"14","author":"Wang","year":"2024","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1002\/joa3.13143","article-title":"The incidence and risk factors of atrial high-rate episodes in patients with a dual-chamber pacemaker","volume":"40","author":"Kieu","year":"2024","journal-title":"J. Arrhythm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.ihj.2022.11.013","article-title":"Incidence of atrial high rate episodes after dual-chamber permanent pacemaker implantation and its clinical predictors","volume":"74","author":"Samuel","year":"2022","journal-title":"Indian. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Nasir, M., Dejene, K., Bedru, M., Ahmed, M., and Markos, S. (2024). Predictors of complications and mortality among patients undergoing pacemaker implantation in resource-limited settings: A 10-year retrospective follow-up study. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-04068-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/IJGM.S448135","article-title":"Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study","volume":"17","author":"Markos","year":"2024","journal-title":"Int. J. Gen. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100387","DOI":"10.1016\/j.jhlto.2025.100387","article-title":"Prognostic value of NT-proBNP monitoring in patients with left ventricular assist devices","volume":"10","author":"Cherbi","year":"2025","journal-title":"JHLT Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e093757","DOI":"10.1136\/bmjopen-2024-093757","article-title":"Clinical implication of NT-proBNP to predict mortality in patients with acute type A aortic dissection: A retrospective cohort study","volume":"15","author":"Liu","year":"2025","journal-title":"BMJ Open"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Popescu, D.C., Ciobanu, M., Tint, D., and Nechita, A.C. (2025). Linking Heart Function to Prognosis: The Role of a Novel Echocardiographic Index and NT-proBNP in Acute Heart Failure. Medicina, 61.","DOI":"10.3390\/medicina61081412"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ianos, R.D., Iancu, M., Pop, C., Lucaciu, R.L., Hangan, A.C., Rahaian, R., Cozma, A., Negrean, V., Mercea, D., and Procopciuc, L.M. (2024). Predictive Value of NT-proBNP, FGF21, Galectin-3 and Copeptin in Advanced Heart Failure in Patients with Preserved and Mildly Reduced Ejection Fraction and Type 2 Diabetes Mellitus. Medicina, 60.","DOI":"10.3390\/medicina60111841"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/12\/1850\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T13:03:38Z","timestamp":1764680618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/12\/1850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,2]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["life15121850"],"URL":"https:\/\/doi.org\/10.3390\/life15121850","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,2]]}}}