Marked Troponin Elevation Mimicking Acute Coronary Syndrome After Pulsed-Field Ablation for Atrial Fibrillation.

BACKGROUND

Pulsed-field ablation (PFA) is an emerging nonthermal modality for atrial fibrillation. Although troponin elevation is common after ablation, markedly elevated levels mimicking acute coronary syndrome (ACS) are uncommon.

CASE PRESENTATION: A 77-year-old woman presented with acute chest pain within 24 hours after undergoing PFA for atrial fibrillation. High-sensitivity troponin I was markedly elevated at 12,221 ng/L. Electrocardiography showed no ischemic changes, and imaging revealed no obstructive coronary artery disease. Serial troponin levels demonstrated a steady decline.

DISCUSSION: Marked troponin elevation may occur after PFA and can mimic ACS. Clinical interpretation should integrate symptoms, electrocardiographic findings, imaging, and biomarker trends rather than relying solely on troponin magnitude.

TAKE-HOME MESSAGE: Markedly elevated troponin levels after PFA may exceed commonly reported ranges and mimic ACS; however, diagnosis should rely on clinical context, electrocardiographic findings, imaging, and biomarker trends rather than on troponin magnitude alone.