Keim Christoph, Wiedenmann Lilli, Schubert Tim, Rothe Moritz, Dobre Bianca C, Kaess Bernhard M, Ehrlich Joachim R, Boehmer Andreas A
Department of Cardiology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany.
Department of Pediatric Cardiology and Congenital Heart Disease, Heidelberg University Hospital, Heidelberg, Germany.
CJC Open. 2025 Mar 10;7(5):571-578. doi: 10.1016/j.cjco.2025.03.004. eCollection 2025 May.
Electrical cardioversion (ECV) is highly effective in restoring sinus rhythm in patients with atrial fibrillation (AF), but it does not influence long-term rhythm control. Remote ischemic preconditioning (RIPC) has demonstrated various cardioprotective effects. Combining ECV with RIPC could provide a promising approach to minimizing AF recurrences after successful ECV.
This prospective, randomized, single-blinded, single-centre study investigated the impact of RIPC on early AF recurrence following successful ECV (defined as sinus rhythm ≥ 30 seconds). Patients were randomized in a 1:1 ratio to receive either RIPC or sham preconditioning before ECV. RIPC was performed in a standardized manner, with 3 cycles of 5-minute forearm ischemia followed by 5 minutes of reperfusion. The primary efficacy endpoint was AF recurrence after 30 days. Safety endpoints included death, stroke, and procedure-related complications. Secondary endpoints were acute ECV success, mean energy, and number of shocks required to restore sinus rhythm.
A total of 240 patients were enrolled. Of these, 214 (89%) had successful ECV. At follow-up, the RIPC group did not show a lower AF recurrence rate, compared to that in the sham group (39% vs 36%, = 0.63), and no effect of RIPC on cardioversion parameters was seen. One stroke occurred in the RIPC group. The study was terminated before the number of prespecified follow-up visits was reached, due to determination of futility.
RIPC did not impact the short-term rhythm-control or cardioversion procedure in patients with AF undergoing ECV.
NCT05342220.
电复律（ECV）在恢复心房颤动（AF）患者的窦性心律方面非常有效，但它不影响长期节律控制。远程缺血预处理（RIPC）已显示出多种心脏保护作用。将ECV与RIPC相结合可能为减少成功ECV后房颤复发提供一种有前景的方法。
这项前瞻性、随机、单盲、单中心研究调查了RIPC对成功ECV（定义为窦性心律≥30秒）后早期房颤复发的影响。患者按1:1比例随机分组，在ECV前接受RIPC或假预处理。RIPC以标准化方式进行，进行3个周期，每个周期包括5分钟的前臂缺血，然后是5分钟的再灌注。主要疗效终点是30天后的房颤复发。安全性终点包括死亡、中风和与手术相关的并发症。次要终点是急性ECV成功率、平均能量和恢复窦性心律所需的电击次数。
共纳入240例患者。其中，214例（89%）成功进行了ECV。随访时，与假手术组相比，RIPC组的房颤复发率没有降低（39%对36%，P = 0.63），且未观察到RIPC对复律参数有影响。RIPC组发生1例中风。由于判定为无效，该研究在达到预定随访次数之前终止。
RIPC对接受ECV的房颤患者的短期节律控制或复律手术没有影响。
NCT05342220。
