Randomized controlled trial of remote ischemic preconditioning and atrial fibrillation in patients undergoing cardiac surgery

Abstract

AIMTo study whether remote ischemic preconditioning (RIPC) has an impact on clinical outcomes, such as post-operative atrial fibrillation (POAF).METHODSThis was a prospective, single-center, single-blinded, randomized controlled study. One hundred and two patients were randomized to receive RIPC (3 cycles of 5 min ischemia and 5 min reperfusion in the upper arm after induction of anesthesia) or no RIPC (control). Primary outcome was POAF lasting for five minutes or longer during the first seven days after surgery. Secondary outcomes included length of hospital stay, incidence of inpatient mortality, myocardial infarction, and stroke.RESULTSPOAF occurred at a rate of 54% in the RIPC group and 41.2% in the control group (P = 0.23). No statistically significant differences were noted in secondary outcomes between the two groups.CONCLUSIONThis is the first study in the United States to suggest that RIPC does not reduce POAF in patients with elective or urgent cardiac surgery. There were no differences in adverse effects in either group. Further studies are required to assess the relationship between RIPC and POAF.

Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Finally, a total of 79 RCTs involving 10,814 patients undergoing cardiac surgery were included in this meta-analysis (Figure 1). 4–8,11–19,26–90…”

Cardioprotective effect of preconditioning is more efficient than postconditioning in rats submitted to cardiac ischemia and reperfusion

“…This cardioprotective mechanism is now being translated into clinical practice, with positive results in several clinical trials in coronary artery bypass surgery, surgical repair of abdominal aortic aneurysms, valve replacement surgery and percutaneous coronary intervention [34][35][36][37][38][39][40] .…”

Remote ischemic preconditioning and its role in the prevention of new onset atrial fibrillation post‐cardiac surgery. A meta‐analysis of randomized control trials

“…The systematic search unveiled a total of 171 eligible articles. Twelve randomized control trials were included in the final analysis . This sums up to a total of 2652 procedures in the remote ischemic preconditioning group and 2667 procedure in the control group.…”

“…Twelve randomized control trials were included in the final analysis. 3,[6][7][8][9][10][11][12][13][14][15][16] This sums up to a total of 2652 procedures in the remote ischemic preconditioning group and 2667 procedure in the control group. There were three prominent studies of the 12 included studies, 10,14,16 which together constituted more than 75% of the patients in the final analysis.…”