Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, #32, Western Section 2, 1st Ring Road, Chengdu, 610072, China.
Department of Heart Failure, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, #32, Western Section 2, 1st Ring Road, Chengdu, 610072, China.
Basic Res Cardiol. 2019 Mar 5;114(3):14. doi: 10.1007/s00395-019-0723-4.
Remote ischaemic preconditioning (RIPC) as adjuvant to selective heart surgery attenuates cardiac injury and atrial fibrillation (AF) occurrence. We investigated its effect on sinus rhythm (SR) restoration rate in permanent AF patients undergoing Cox maze (CM) radiofrequency ablation with concomitant mitral valve surgery. From May 2013 to May 2017, 206 patients with rheumatic valve disease concomitant with permanent AF were randomized to receive prosthesis valve replacement and CM radiofrequency ablation procedure with (n = 104) or without (n = 102) RIPC (intermittent arm ischaemia through three cycles of 5-min inflation, followed by 5-min deflation of a blood pressure cuff). The primary end point of the study was freedom from cumulative AF without using antiarrhythmic drugs 1 year after operation; the secondary end points included inflammation reaction index over 48 h postoperatively and clinical outcomes. Baseline characteristics and preoperative data did not differ between groups. The SR restoration rates were significantly higher in the RIPC group, 85.6%, 83.7%, and 82.7%, than those in the control group, 72.5%, 70.6%, and 69.6%, at discharge, 6 months and 12 months, respectively, after the radiofrequency ablation procedure (P < 0.05). The serum concentration of high sensitivity C-reactive protein and neutrophil-lymphocyte ratio were significantly decreased at 12 h, 24 h, and 48 h postoperatively in the RIPC group compared to those in the control group (P < 0.05). RIPC induced by brief ischaemia and reperfusion of the arm ameliorated SR restoration rate in patients with permanent AF through CM radiofrequency ablation procedure and was associated with reduction of postoperative systemic inflammation reaction index.
远程缺血预处理（RIPC）作为选择性心脏手术的辅助手段，可减轻心脏损伤和心房颤动（AF）的发生。我们研究了其对行 Cox 迷宫（CM）射频消融术同时行二尖瓣手术的永久性 AF 患者窦性心律（SR）恢复率的影响。2013 年 5 月至 2017 年 5 月，206 例风湿性瓣膜病合并永久性 AF 患者随机分为接受假体瓣膜置换术和 CM 射频消融术的患者（n = 104）或不接受 RIPC（n = 102）的患者（间歇性臂缺血通过三个 5 分钟充气、5 分钟放气的循环）。研究的主要终点是术后 1 年无累积 AF 且无需使用抗心律失常药物；次要终点包括术后 48 小时内炎症反应指标和临床结局。两组患者的基线特征和术前数据无差异。RIPC 组 SR 恢复率明显高于对照组，分别为出院时 85.6%、83.7%和 82.7%，术后 6 个月时 72.5%、70.6%和 69.6%，术后 12 个月时 82.7%、80.3%和 79.6%（P < 0.05）。RIPC 组术后 12、24 和 48 小时血清高敏 C 反应蛋白和中性粒细胞-淋巴细胞比值均明显低于对照组（P < 0.05）。短暂的手臂缺血和再灌注 RIPC 通过 CM 射频消融术改善了永久性 AF 患者的 SR 恢复率，并与术后全身炎症反应指数降低相关。
