Arrhythmias and Conduction Disturbances
Effects of Alpha Lipoic Acid on Multiple Cytokines and Biomarkers and Recurrence of Atrial Fibrillation Within 1 Year of Catheter Ablation

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Catheter ablation (CA) is a procedure commonly used to restore sinus rhythm in patients with atrial fibrillation (AF). However, AF recurrence after CA remains a relevant clinical issue. We tested the effects of an oral antioxidant treatment (alpha lipoic acid [ALA]) on AF recurrence post-CA. Patients with paroxysmal AF have been enrolled in a randomized, prospective, double-blind, controlled placebo trial. After CA, patients have been randomly assigned to receive ALA oral supplementation (ALA group) or placebo (control group) and evaluated at baseline and after a 12-month follow-up: 73 patients completed the 12-month follow-up (ALA: 33 and control: 40). No significant difference has been detected between the 2 groups at baseline. Strikingly, 1 year after CA, ALA therapy significantly reduced serum markers of inflammation. However, there was no significant difference in AF recurrence events at follow-up comparing ALA with placebo group. Multivariate analysis revealed that the only independent prognostic risk factor for AF recurrence after CA is age. In conclusion, ALA therapy reduces serum levels of common markers of inflammation in ablated patients. Nevertheless, ALA does not prevent AF recurrence after an ablative treatment.

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Methods

From January 2012 to May 2014 (phase 1), 153 patients with paroxysmal, symptomatic AF and ≥ 6-month refractory to ≥1 class 1 to 3 antiarrhythmic drugs (AADs) have been identified and screened for participation in this randomized, prospective, double-blind, controlled placebo trial at the Catholic University of Sacred Heart, Campobasso, Italy, at the “John Paul II” Research and Care Foundation, Campobasso, Italy, and at the Second University of Studies of Naples, Italy. AF and paroxysmal AF were

Results

The study was completed by 73 patients (ALA group: 33; control group: 40). No significant differences between the 2 groups have been detected in clinical parameters at baseline (Table 1). Similarly, at baseline, no differences have been reported in circulating serum levels of tumor necrosis factor alpha (TNF-α), interleukins (IL-6, IL-8, IL-10), nitrotirosine, CRP, and N-terminal pro-brain natriuretic peptide, as listed in Table 2.

At 12-month follow-up, patients in the ALA supplementation group

Discussion

In the present study, we show that after an ablation treatment ALA treated patients have shown significantly lower inflammation compared with the placebo group. Importantly, inflammation has been described as triggering in AF pathogenesis and perpetuation.10, 12 CA treatment may initiate an acute inflammatory response17 that could affect atrial function and postablation outcomes. Indeed, the post-CA adaptive processes lead to electroanatomic alterations in atrial myocardium that may be

Disclosures

The authors have no conflicts of interest to disclose.

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    Dr. Santulli is supported by the grant K99/R00 DK107895 from the National Institutes of Health.

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