Zhang Yuji, Po Sunny S, Xin Fangran, Zhao Jikai, Zhao Keyan, Tao Dengshun, Chakraborty Praloy, Yin Zongtao, Liu Guannan, Wang Huishan
Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
JACC Clin Electrophysiol. 2025 Apr;11(4):776-788. doi: 10.1016/j.jacep.2024.11.014. Epub 2025 Jan 22.
Calcium-mediated autonomic denervation has been shown to suppress postoperative atrial fibrillation (POAF) after coronary artery bypass grafting.
This study sought to evaluate whether similar autonomic denervation can prevent POAF after mitral or aortic valve surgeries.
This research consisted of 2 single-center, randomized, double-blind, sham-controlled trials: CAP-AF2 (Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Mitral Valve Surgery for Mitral Regurgitation) for mitral valve (MV) surgery and CAP-AF3 (Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Aortic Valve Surgery) for aortic valve surgery. Patients were randomized to receive injections of either 5% CaCl or 0.9% NaCl (control) into the atrial ganglionated plexi during surgery. The primary outcome was the incidence of POAF ≥30 seconds within 7 days after surgery. Secondary outcomes included hospital stay, AF burden, actionable antiarrhythmic therapy for POAF, and inflammatory marker.
After 160 patients were enrolled into the CAP-AF2 trial, mid-term analysis revealed a significant increase in POAF incidence in the CaCl group (55.13%, CaCl vs 37.80%, NaCl; P = 0.028). The CAP-AF2 trial was terminated by the safety committee. In the CAP-AF3 trial, 239 patients were randomized; final analysis showed no significant difference in the POAF incidence between the CaCl and NaCl groups (35.59% vs 39.67%, P = 0.516). Postoperative hospital stay, AF burden, antiarrhythmic therapy for POAF, and plasma levels of inflammatory markers were not different between the 2 groups in both trials. Immunohistochemical analyses showed parasympathetic predominance at the tissue level in patients receiving MV surgery.
Calcium-mediated autonomic denervation did not uniformly prevent POAF across all cardiac surgeries, with an increased incidence observed in the MV surgery group, highlighting the need for disease-specific strategies to prevent POAF. (Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Mitral Valve Surgery for Mitral Regurgitation [CAP-AF2]; ChiCTR2000029314; Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Aortic Valve Surgery [CAP-AF3]; ChiCTR2000029313).
钙介导的自主神经去神经支配已被证明可抑制冠状动脉搭桥术后的术后房颤（POAF）。
本研究旨在评估类似的自主神经去神经支配是否能预防二尖瓣或主动脉瓣手术后的POAF。
本研究包括两项单中心、随机、双盲、假手术对照试验：用于二尖瓣（MV）手术的CAP-AF2（钙自主神经去神经支配预防二尖瓣反流孤立二尖瓣手术患者术后房颤）和用于主动脉瓣手术的CAP-AF3（钙自主神经去神经支配预防孤立主动脉瓣手术患者术后房颤）。患者在手术期间被随机分配接受向心房神经节丛注射5%氯化钙或0.9%氯化钠（对照）。主要结局是术后7天内持续时间≥30秒的POAF发生率。次要结局包括住院时间、房颤负荷、针对POAF的可采取行动的抗心律失常治疗以及炎症标志物。
在160例患者入组CAP-AF2试验后，中期分析显示氯化钙组的POAF发生率显著增加（55.13%，氯化钙组 vs 37.80%，氯化钠组；P = 0.028）。CAP-AF2试验由安全委员会终止。在CAP-AF3试验中，239例患者被随机分组；最终分析显示氯化钙组和氯化钠组的POAF发生率无显著差异（35.59% vs 39.67%，P = 0.516）。两项试验中两组之间的术后住院时间、房颤负荷、针对POAF的抗心律失常治疗以及炎症标志物的血浆水平均无差异。免疫组织化学分析显示接受MV手术患者在组织水平上以副交感神经占主导。
钙介导的自主神经去神经支配并不能在所有心脏手术中一致地预防POAF，在MV手术组中观察到发生率增加，这突出了需要针对特定疾病的策略来预防POAF。（钙自主神经去神经支配预防二尖瓣反流孤立二尖瓣手术患者术后房颤[CAP-AF2]；ChiCTR2000029314；钙自主神经去神经支配预防孤立主动脉瓣手术患者术后房颤[CAP-AF3]；ChiCTR2000029313）
