Ischemic Preconditioning Suppresses Ventricular Tachyarrhythmias After Myocardial Revascularization

Wu, Zhongkai; Iivainen, Tiina; Pehkonen, Erkki; Laurikka, Jari; Tarkka, Matti

doi:10.1161/01.cir.0000041430.32233.5b

Cited by 96 publications

(60 citation statements)

References 26 publications

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“…Preconditioning may reduce reperfusion arrhythmias (Yellon 2003), also in humans as demonstrated in CABG patients. An ischemic preconditioning protocol by aortic cross-clamping was applied, and the incidence of postoperative ventricular arrhythmias was reduced in the preconditioned group as compared to control patients (Wu 2002). Ischemic preconditioning affects the myocardial metabolism during the subsequent index ischemia generally by slowing down myocardial ischemic metabolism as compared to non-preconditioned ischemic control.…”

Section: Myocardial Preconditioningmentioning

confidence: 99%

Myocardial ischemia-reperfusion and cardioprotection: a study with microdialysis in a porcine model

Metzsch

2011

Acta Anaesthesiologica Scandinavica

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Section: Myocardial Preconditioningmentioning

confidence: 99%

Myocardial ischemia-reperfusion and cardioprotection: a study with microdialysis in a porcine model

Metzsch

2011

Acta Anaesthesiologica Scandinavica

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“…16 Notable in this regard is the general lack of information regarding preconditioning in humans. This is rectified in the current issue of Circulation by the article by Wu and colleagues, 17 who report a study in humans in which they examined the effect of a preconditioning protocol on perioperative and postoperative arrhythmias. They studied 86 patients undergoing coronary artery bypass surgery.…”

Section: See P 3091mentioning

confidence: 99%

“…Postoperative nonsustained ventricular tachycardia (VT) developed in the majority of patients in the control group (97.7%) but in only 55.8% of the preconditioning group. As pointed out by the authors, 17 although nonsustained VT during postcardioplegic reperfusion tends to be a benign, short-lived event, it is usually considered to reflect ischemia/reperfusion injury. Postoperative sustained VT occurred in 3 control patients but in none of the patients in the preconditioning group.…”

Section: See P 3091mentioning

confidence: 99%

“…The possibility of a practical application is enhanced by the relatively brief period of preconditioning ischemia used. In this study, 17 the preconditioning protocol used two 2-minute periods of ischemia. Although this might be considered rather short to induce preconditioning, 18 it seems to have been sufficient to achieve an effect in these patients undergoing surgery.…”

Section: See P 3091mentioning

confidence: 99%

“…In the meantime, Wu and colleagues 17 should be congratulated on their study and for providing convincing evidence that preconditioning may protect against ischemia/reperfusion arrhythmias in humans. This should further fuel endeavors to find answers to the multiplicity of questions surrounding the effect of preconditioning on arrhythmogenesis.…”

Section: See P 3091mentioning

confidence: 99%

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Preconditioning and Arrhythmias

Taggart

Yellon

2002

Circulation

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A brief episode of myocardial ischemia confers endogenous cardioprotection during a subsequent prolonged period of ischemia. This phenomenon, known as preconditioning, 1 offers one of the most powerful mechanisms for reducing the speed and extent of myocardial cell damage resulting from an acute or sustained ischemic insult. This protection has been shown to occur in a wide variety of animal species, including man, and exists in two forms, namely an early or classic preconditioning 1 and delayed or second window of protection. 2 The "gold standard" used in these animal studies for assessing a preconditioning effect has been measurement of the extent of limitation of infarct size. 3 Studies in humans therefore necessarily rely on a less direct approach. 4 For example, clinical observation has shown that the occurrence of episodes of angina shortly before a myocardial infarction reduces mortality and morbidity. 4,5 In the setting of percutaneous transluminal coronary angiography, it has been shown that measures of ischemia, such as angina and ST elevation, in the ECG occurring during the period when the coronary artery is occluded by the inflated balloon are less during a second balloon inflation compared with the first. 6 -8 These studies are not always easy to interpret, however, because of confounding variables such as uncertainties about the recruitment of collaterals in response to the preconditioning ischemia, the adequacy of the very short See p 3091duration of ischemia sometimes used during the preconditioning phase, and the use of the amount of ST segment shift in the ECG as a quantitative measure of ischemia. 4 One study largely overcomes the uncertainties with regard to collateral flow in patients undergoing percutaneous transluminal coronary angiography and demonstrates an antiarrhythmic effect of preconditioning. 9 Possibly the most direct evidence for the occurrence of preconditioning in humans comes from studies in patients undergoing coronary artery surgery, where it has been shown that the introduction of two 3-minute periods of global ischemia early in the operation reduced the loss of high energy phosphates 10 and troponin T after the subsequent prolonged period of ischemia during the fashioning of the coronary graft anastomoses. 11,12 Thus, overall, the available evidence supports the notion that preconditioning not only occurs in humans but does so within context of clinical procedures and as such may be of potential benefit to patients.Whereas preconditioning has been shown to dramatically reduce infarct size in all species studied, the situation with regard to surrogate endpoints 13 such as ventricular arrhythmias is less clear. The majority of studies in animal models report a reduction in arrhythmias after preconditioning protocols. 14,15 Some studies, on the other hand, report a worsening of arrhythmias. For example, in the original study by Murray et al, 1 there was a trend to an increased susceptibility to ventricular fibrillation (VF) in preconditioned dogs. In another study, although ...

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Ischaemic preconditioning for heart surgery

Ghanbari¹,

Desai²,

Gurusamy³

et al. 2010

The Cochrane Database of Systematic Reviews

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Ischemic Preconditioning Suppresses Ventricular Tachyarrhythmias After Myocardial Revascularization

Abstract: IP significantly reduced postoperative VF/VT in patients with CABG with 3-vessel disease. Suppression of VT during early reperfusion and 24 hours after reperfusion suggests early and delayed IP phenomena in patients undergoing CABG surgery.

Cited by 96 publications

References 26 publications

Myocardial ischemia-reperfusion and cardioprotection: a study with microdialysis in a porcine model

Myocardial ischemia-reperfusion and cardioprotection: a study with microdialysis in a porcine model

Preconditioning and Arrhythmias

Ischaemic preconditioning for heart surgery

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