Serum Troponin and Procedural Duration Predict Delayed iASD Closure After Left Atrial Arrhythmia Ablation

Background: Transseptal puncture is routinely performed to access the left atrium during catheter ablation of left atrial tachyarrhythmias. Although iatrogenic atrial septal defects (iASDs) frequently occur after the procedure, factors influencing delayed defect closure remain incompletely understood. Myocardial injury induced by radiofrequency (RF) ablation results in the release of cardiac troponin into the circulation and may reflect the extent of procedural tissue injury. Methods: This prospective study included patients who underwent RF ablation for left atrial arrhythmias at the Iraqi Center for Heart Diseases in collaboration with the College of medicine, University of Baghdad between March 2023 and April 2024. Serum troponin concentrations, procedural duration, and echocardiographic assessment of iASD size were evaluated prospectively to determine their association with delayed atrial septal defect closure over a period of 3–6 months. Results: Forty-seven patients were enrolled (mean age, 36.28 ± 10.34 years; 48.9% male). A significant positive association was observed between iASD size and serum troponin level (p < 0.001). For each unit increase in post-procedure troponin, the likelihood of ASD presence increases by more than two-fold at 3–6 months. Larger septal defects were also associated with longer procedural duration. Conclusions: Elevated serum troponin concentration following RF ablation is associated with larger iatrogenic atrial septal defects and may serve as a useful predictor of delayed iASD closure during the first six months of follow-up.