Effect of Remote Ischemic Preconditioning on Platelet Activation and Reactivity Induced by Ablation for Atrial Fibrillation
Background—Radiofrequency (RF) ablation of atrial fibrillation (AF) has been associated with some risk of thromboembolic events. Previous studies showed that preventive shorts episodes of forearm ischemia (remote ischemic preconditioning [IPC]) reduce exercise-induced platelet reactivity. In this study we assessed whether remote IPC has any effect on platelet activation induced by RF ablation of AF.
Methods and Results—We randomized 19 patients (54.7±11 years, 17 males), undergoing RF catheter of paroxysmal AF, to receive remote IPC or sham intermittent forearm ischemia (controls) before the procedure. Blood venous samples were collected before and after remote IPC/sham ischemia, at the end of the ablation procedure and 24 hours later. Platelet activation and reactivity were assessed by flow cytometry by measuring monocyte-platelet aggregate (MPA) formation, platelet CD41 in the MPA gate and platelet CD41 and CD62 in the platelet gate, in absence and in presence of ADP stimulation. At baseline there were no differences between groups in platelet variables. RF ablation induced platelet activation in both groups, which persisted after 24 hours. However, compared controls, remote IPC patients showed a lower increase in all platelet variables, including MPA formation (p<0.0001), CD41 in the MPA gate (p=0.002) and CD41 (p<0.0001) and CD62 (p=0.002) in the platelet gate. Compared to controls, remote IPC was also associated with a significant lower ADP-induced increase of all platelet markers.
Conclusions—Our data show that remote IPC before RF catheter ablation for paroxysmal AF significantly reduces the increased platelet activation and reactivity associated with the procedure.
- Received July 29, 2013.
- Revision received September 16, 2013.
- Accepted October 7, 2013.