Key result
Preemptive left stellate ganglion block reduces postoperative AF odds by ~71% vs. control.
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Why the study?
Postoperative atrial fibrillation is associated with sympathetic overactivity, and the stellate ganglion is a potential target for intervention to reduce POAF after coronary artery bypass grafting.
Does preemptive left stellate ganglion block reduce the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass?
RCT (n=124)
Does preemptive left stellate ganglion block reduce the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass?
Odds Ratio: 0.288 (95% CI 0.106–0.731)
Absolute Event Rate: 18.5% vs 44.4%
p-value: p=0.007
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Whether SGB itself ultimately becomes part of routine perioperative care remains uncertain and will require confirmation in adequately powered multicenter trials with longer follow-up.”
“Whether preemptive left SGB can reduce POAF in patients undergoing the entire spectrum of cardiac operations requires testing in a large sample and multicenter study.”
Preemptive left stellate ganglion block significantly reduces the incidence of postoperative atrial fibrillation within 5 days after coronary artery bypass grafting.
BACKGROUND Postoperative atrial fibrillation (POAF) is associated with sympathetic overactivity. Stellate ganglion is a potential target for intervention. OBJECTIVES The aim of this study was to examine the efficacy of preemptive left stellate ganglion block (SGB) in reducing POAF in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. METHODS Patients were randomized to the SGB group or the control group. The primary endpoint was the incidence of POAF within 5 days postoperatively. Secondary endpoints included POAF-associated characteristics and recovery indicators. RESULTS A total of 124 patients underwent initial randomization, with 108 in modified intention-to-treat and 98 in per-protocol analysis. In modified intention-to-treat analysis, POAF occurred in 18.5% of the SGB group and 44.4% of the control group (OR: 0.288; 95% CI: 0.106-0.731; P = 0.007). Per-protocol analysis yielded consistent results. SGB group showed significantly lower POAF burden, shorter duration of first POAF episode, fewer POAF episodes and antiarrhythmic treatments, decreased C-reactive protein, interleukin-6, high-sensitivity cardiac troponin T, and creatine kinase-MB on certain postoperative time points, and decreased postoperative hospitalization than the control group (all P < 0.05). Exploratory subgroup analyses suggested that the association between SGB pretreatment and lower POAF incidence was more pronounced among patients without diabetes (OR: 0.10; 95% CI: 0.019-0.480; P = 0.004) and those at lower baseline risk of POAF (OR: 0.10; 95% CI: 0.005-0.642; P = 0.040). CONCLUSIONS In patients undergoing coronary artery bypass grafting with cardiopulmonary bypass, preemptive left SGB was associated with a reduced incidence of POAF within 5 postoperative days. Exploratory subgroup analyses suggested a potentially greater association among patients without diabetes and those at lower risk of POAF.
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Tian et al. (2026) conducted an RCT in Postoperative atrial fibrillation after coronary artery bypass grafting (n=124). Preemptive left stellate ganglion block (SGB) vs. Control group was evaluated on Incidence of POAF within 5 days postoperatively (OR 0.288, 95% CI 0.106-0.731, p=0.007). Preemptive left stellate ganglion block significantly reduced the incidence of postoperative atrial fibrillation compared to control (18.5% vs 44.4%; OR 0.288; 95% CI 0.106-0.731; P=0.007).
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