Effect of remote ischemic preconditioning on myocardial injury and inflammatory response induced by ablation for atrial fibrillation: A randomized controlled trial

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• 作者：Ruijuan Han^a ; Xiaoqing Liu^a ; XianDong Yin^a ; Meili Zheng^a ; Kai Sun^b ; Xingpeng Liu^a ; Ying Tian^a ; Xinchun Yang^a ; ^{yxc_6229@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Remote ischemic preconditioning ; Atrial fibrillation ; Catheter ablation ; Myocardial damage ; Inflammatory response
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：396-400
• 全文大小：299 K

文摘

Remote ischemic preconditioning (RIPC) has been suggested to reduce postoperative release of cardiac and inflammatory markers in patients undergoing cardiac surgery. This study aimed to evaluate the effect of RIPC on nonischemic myocardial damage and inflammatory response in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation (AF).

Methods

Seventy-two patients with drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation were randomized into RIPC or control groups. RIPC (intermittent arm ischemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff) was performed once daily on 2 consecutive days before the ablation and immediately before ablation. Cardiac troponin-I (cTnI), high-sensitive C-reactive protein (hs-CRP), and interleukin (IL)-6 levels were measured before RIPC/sham RIPC, after the ablation, and 24 and 72 h later. The early recurrence of atrial fibrillation (ERAF) in the two groups was observed over the subsequent 3 months.

Results

Radiofrequency ablation resulted in a significant rise in cTnI, hs-CRP, and IL-6 in both groups, which persisted for 72 h. The RIPC group showed a lower increase in cTnI (P < 0.001), hs-CRP (P = 0.003), and IL-6 (P = 0.008) than the control and tended to have a lower risk of ERAF (hazard ratio [HR] = 0.77, 95% confidence interval [CI]: 0.32–1.88).

Conclusions

These results show that RIPC before ablation for paroxysmal AF significantly reduces the increase in cTnI, hs-CRP, and IL-6 associated with the procedure and results in a lower risk of ERAF. These findings suggest that RIPC could provide cardioprotection against nonischemic myocardial damage.