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Remote ischaemic preconditioning ameliorates sinus rhythm restoration rate through Cox maze radiofrequency procedure associated with inflammation reaction reduction

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Abstract

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.

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Acknowledgements

This work was supported by the clinical study and translation grant of Sichuan Provincial People’s Hospital (2017LY07) and the National Natural Science and Technology Foundation of China (81800274).

Funding

This work was supported by the clinical study and translation grant of Sichuan Provincial People’s Hospital (2017LY07) and the National Natural Science and Technology Foundation of China (81800274).

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  1. Qin Jiang, Bo Xiang, and Haitao Wang contributed equally.

Authors and Affiliations

  1. 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

    Qin Jiang, Bo Xiang, Haitao Wang & Keli Huang

  2. 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

    Hong Kong

  3. Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China

    Shengshou Hu

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The manuscript has not been submitted elsewhere and is not under consideration for publication. All authors have read and agreed with the submission of the manuscript. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Correspondence to Qin Jiang.

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All participants in the study gave written informed consent in accordance with the Declaration of Helsinki. Both studies were approved by the Ethics Committee of Sichuan Provincial People’s Hospital, Chengdu, China.

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Jiang, Q., Xiang, B., Wang, H. et al. Remote ischaemic preconditioning ameliorates sinus rhythm restoration rate through Cox maze radiofrequency procedure associated with inflammation reaction reduction. Basic Res Cardiol 114, 14 (2019). https://doi.org/10.1007/s00395-019-0723-4

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