Key result
Autonomic neuromodulation therapies reduce POAF incidence by ~63% after cardiac surgery.
Why the study?
Very little is known about the preventive potential of autonomic neuromodulation therapies for postoperative atrial fibrillation after cardiac surgery.
Meta-Analysis
Odds Ratio: 0.37 (95% CI 0.25–0.55)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's too early to say that thousands of people should go out and get this, especially since it is an invasive procedure, but it definitely increases the appetite in the field for looking more into these autonomic neuromodulation therapies for cardiovascular disease, and arrhythmias in particular.”
“This study shows VNS and other autonomic neuromodulation techniques may help patients recover more quickly and avoid potential complications after heart surgery.”
Meta-analysis demonstrates reduced postoperative atrial fibrillation after cardiac surgery with autonomic neuromodulation, indicating a promising preventive approach.
Autonomic neuromodulation therapies (ANMTs) (ie, ganglionated plexus ablation, epicardial injections for temporary neurotoxicity, low-level vagus nerve stimulation [LL-VNS], stellate ganglion block, baroreceptor stimulation, spinal cord stimulation, and renal nerve denervation) constitute an emerging therapeutic approach for arrhythmias. Very little is known about ANMTs' preventive potential for postoperative atrial fibrillation (POAF) after cardiac surgery. The purpose of this review is to summarize and critically appraise the currently available evidence. Herein, the authors conducted a systematic review of 922 articles that yielded 7 randomized controlled trials. In the meta-analysis, ANMTs reduced POAF incidence (OR: 0.37; 95% CI: 0.25 to 0.55) and burden (mean difference [MD]: -3.51 hours; 95% CI: -6.64 to -0.38 hours), length of stay (MD: -0.82 days; 95% CI: -1.59 to -0.04 days), and interleukin-6 (MD: -79.92 pg/mL; 95% CI: -151.12 to -8.33 pg/mL), mainly attributed to LL-VNS and epicardial injections. Moving forward, these findings establish a base for future larger and comparative trials with ANMTs, to optimize and expand their use.
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Zafeiropoulos et al. (2022) conducted a meta-analysis in Postoperative atrial fibrillation (POAF) after cardiac surgery. Autonomic neuromodulation therapies (ANMTs) was evaluated on POAF incidence (OR 0.37, 95% CI 0.25 to 0.55). Autonomic neuromodulation therapies reduced the incidence of postoperative atrial fibrillation after cardiac surgery (OR 0.37; 95% CI 0.25 to 0.55).
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