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Background  Since the introduction of high-sensitivity troponin assays a greater proportion of atrial fibrillation (AF) patients present with dynamic troponin elevations. We hypothesize that significant coronary artery disease (CAD) causes relative ischemia in the setting of a rapid heart rate resulting in dynamic troponin elevation. The aim of this study was to examine if patients without known CAD who present with AF, tachycardia and dynamic high-sensitivity troponin T (hsTnT) change have an increased risk of cardiac events.    Methods  We retrospectively included AF patients presenting with tachycardia during one year. The primary endpoint was acute coronary syndrome, revascularization or death due to ischemic heart disease during 30 months follow-up.    Results  Five hundred twenty-two patients without known CAD were included, 300 (57%) had normal hsTnT and 49 (9.5%) had dynamic hsTnT elevation. During follow-up 12 (4%) patients with normal hsTnT reached the primary endpoint and a total of 14 (4.7%) patients died. In the group with dynamic hsTnT the results were 4 (8.2%) and 12 (25%) respectively. The age-adjusted hazard ratio (HR) for the primary endpoint in patients with dynamic hsTnT was 1.9 (95% CI: 0.6 to 6.2;  p  = 0.28) and for all-cause mortality 3.8 (95% CI: 1.7 to 8.5;  p  = 0.001).    Conclusions  Dynamic hsTnT elevation in connection with AF might not be associated with any major increased risk of coronary events, but indicates increased all-cause mortality.    Electronic supplementary material  The online version of this article (doi:10.1186/s12872-017-0601-7) contains supplementary material, which is available to authorized users.

Dynamic high-sensitivity troponin elevations in atrial fibrillation patients might not be associated with significant coronary artery disease