Remote Ischemic Preconditioning for Electrical Cardioversion of Atrial Fibrillation—the Prospective Randomized PRECON-AF Study

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-05-01 DOI:10.1016/j.cjco.2025.03.004

Christoph Keim BSc , Lilli Wiedenmann BSc , Tim Schubert BSc , Moritz Rothe MD , Bianca C. Dobre MD , Bernhard M. Kaess MD , Joachim R. Ehrlich MD , Andreas A. Boehmer MD

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Abstract

Background

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.

Methods

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.

Results

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%, P = 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.

Conclusions

RIPC did not impact the short-term rhythm-control or cardioversion procedure in patients with AF undergoing ECV.

Clinical Trial Registration

NCT05342220.

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房颤电转复的远程缺血预处理-前瞻性随机PRECON-AF研究

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，但它不影响长期的心律控制。远端缺血预处理（RIPC）已显示出多种心脏保护作用。将ECV与RIPC相结合可以提供一种很有前途的方法来减少ECV成功后房颤的复发。方法这项前瞻性、随机、单盲、单中心研究调查了RIPC对体外循环成功（定义为窦性心律≥30秒）后早期房颤复发的影响。患者按1:1的比例随机分配，在ECV前接受RIPC或假预处理。RIPC以标准化方式进行，前臂缺血5分钟，再灌注5分钟，3个周期。主要疗效终点为房颤30天后复发。安全性终点包括死亡、中风和手术相关并发症。次要终点是急性ECV成功、平均能量和恢复窦性心律所需的电击次数。结果共纳入240例患者。其中214例（89%）ECV成功。随访时，与假手术组相比，RIPC组的房颤复发率没有降低（39% vs 36%, P = 0.63）， RIPC对心律转复参数也没有影响。RIPC组发生1例卒中。在达到预定随访次数之前，由于确定无效，研究终止。结论ripc对房颤ECV患者的短期心律控制或心律转复无影响。临床试验注册nct05342220。

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