Effect of remote ischemic preconditioning on left atrial remodeling and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation

• Published in: Pacing and clinical electrophysiology 2018-03, Vol.41 (3), p.246-254
• Main Authors: Han, Ruijuan, Liu, Xiaoqing, Zheng, Meili, Zhao, RuiPing, Liu, XiaoYan, Yin, Xiandong, Liu, Xingpeng, Tian, Ying, Shi, Liang, Sun, Kai, Yang, Xinchun
• Format: Article
• Language: English
• Subjects: Aged; atrial fibrillation; Atrial Fibrillation - surgery; Atrial Remodeling; Biomarkers - blood; Cardiac arrhythmia; Catheter Ablation; Catheters; Enzyme-Linked Immunosorbent Assay; Female; Fibrillation; Flow Cytometry; Forearm; Humans; Ischemia; Ischemic Preconditioning; left atrial remodeling; Male; Matrix metalloproteinase; Matrix Metalloproteinase 9 - blood; Metalloproteinase; P-Selectin - blood; Platelet Glycoprotein GPIIb-IIIa Complex - metabolism; Platelets; Prospective Studies; prothrombotic response; Radiofrequency ablation; remote ischemic preconditioning; Treatment Outcome; Von Willebrand factor; von Willebrand Factor - metabolism
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.13271

Background Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is known to induce left atrial remodeling and prothrombotic response. Aims This study aimed to evaluate the effect of remote ischemic preconditioning (RIPC) on left atrial remodeling and prothrombotic response induced by RFCA of AF. Methods Forty‐four patients with drug‐refractory paroxysmal AF undergoing RFCA were randomized into RIPC (four short episodes of forearm ischemia) and control groups before the procedure. Blood samples were collected before RIPC/sham RIPC, and 24 and 72 hours later after the procedure. The atrial remodeling marker matrix metalloproteinase‐9 (MMP‐9) and endothelial damage marker von Willebrand factor (vWF) were measured using enzyme‐linked immunosorbent assay. Platelet activation was evaluated by flow cytometric measurements of the expression of platelet P‐selectin (CD62P) and active glycoprotein IIb/IIIa receptor (PAC‐1). The early recurrence of atrial fibrillation (ERAF) in the two groups was observed over the subsequent 3 months. Results RFCA resulted in a significant increase in MMP‐9 and vWF in both the groups, which persisted for 72 hours. However, the expression of CD62P and PAC‐1 showed less increase during RFCA in either group. The RIPC group showed a lower increase in MMP‐9 and vWF compared with the control group. In contrast, no significant differences were found in the trend of expression of CD62P and PAC‐1 during RFCA between the two groups. The AF recurrence in the 3 months after the ablation was significantly lower in the RIPC group than in the control group. Conclusions RIPC before RFCA for paroxysmal AF significantly reduces the increase in markers of left atrial remodeling and endothelial damage associated with the procedure, and results in a lower ERAF.