Troponin rise and poor outcome in patients with acute atrial fibrillation: rationale and criteria of selection of patients

To the Editor, The role of new onset atrial fibrillation (AF) as a marker of thromboembolic risk has been demonstrated in the setting of acute myocardial infarction [1-3]. [...]someone might inquire the role of acute AF in patients with abnormal troponin not fulfilling criteria of acute myocardial infarction and might question if the minor reported range of troponin I (cTn-I) values in the study population of Conti et al [4] (from 0.15 to 7.0 ng/mL) may not be linked with a secondary ischemic mechanism, likely an imbalance between demand and supply [5]. [...]in the study by Conti et al [4], the mean heart rate was the same in patients with or without cTn-I elevations, and the fast ventricular response as cause of the increased oxygen demand leading to ischemia could not likely be assured. [...]masked coronary heart disease might be suggested as the rational element of the potential underlying mechanism of the cTn-I elevation because the presence of known ischemic vascular disease in these patients significantly predicts the primary end point.