title: Effect of remote ischemic preconditioning on myocardial injury and inflammatory response induced by ablation for atrial fibrillation: A randomized controlled trial.
abstract: BACKGROUND
  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 72h later. The early recurrence of atrial fibrillation (ERAF) in the two groups was observed over the subsequent 3months.
  
  
  RESULTS
  Radiofrequency ablation resulted in a significant rise in cTnI, hs-CRP, and IL-6 in both groups, which persisted for 72h. 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.
authors: Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors: Ruijuan
authors: R
authors: Han
authors: Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors: Xiaoqing
authors: X
authors: Liu
authors: Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors: XianDong
authors: X
authors: Yin
authors: Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors: Meili
authors: M
authors: Zheng
authors: Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xi-Cheng District, Beijing 100037, China.
authors: Kai
authors: K
authors: Sun
authors: Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors: Xingpeng
authors: X
authors: Liu
authors: Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors: Ying
authors: Y
authors: Tian
authors: Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China. Electronic address: yxc_6229@163.com.
authors: Xinchun
authors: X
authors: Yang
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000209:etiology; D018836:Inflammation Mediators / Q000097:blood*; D019194:Ischemic Preconditioning / Q000379:methods* / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018836:Inflammation Mediators
keywords: Atrial fibrillation; Catheter ablation; Inflammatory response; Myocardial damage; Remote ischemic preconditioning