Prophylactic cardiac denervation to prevent post-operative atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.

BACKGROUND

Despite revolutionary advances in the field of percutaneous coronary intervention (PCI), a significant number of patients with coronary artery disease (CAD) require coronary artery bypass grafting (CABG), which is associated with postoperative atrial fibrillation (POAF) risk. This meta-analysis evaluates the efficacy and safety of prophylactic cardiac denervation (PCD) during CABG to prevent POAF.

METHODS

A systematic search was conducted across PubMed, CENTRAL, Web of Science, Scopus, and Embase until December 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with a 95% confidence interval (CI). This systematic review and meta-analysis is registered with PROSPERO ID: CRD42025631310.

RESULTS

Five studies with 1266 patients were included in the final analysis. Compared to CABG alone, CABG plus PCD did not show any significant difference in the incidence of POAF (RR 0.77, [95% CI 0.38, 1.56], p = 0.47, I = 83%) and all-cause mortality (RR 0.70, [95% CI 0.19, 2.51], p = 0.58, I = 0). Additionally, there was no significant difference between both groups in cross-clamp time (MD: 0.68, [95% CI - 1.22, 2.57], p = 0.48, I = 26%), cardiopulmonary bypass time (MD - 0.04 [95% CI - 5.29, 5.21], p = 0.99, I = 82%), length of hospital stay (MD - 0.13 [95% CI - 0.55, 0.29], p = 0.54, I = 59%), blood loss (MD 2.22, [95% CI - 23.60, 28.03], p = 0.87, I = 0%), and number of grafts (MD 0.21, [95% CI - 0.07, 0.49], p = 0.13, I = 91%).

CONCLUSION

CABG with adjuvant PCD did not show significant efficacy in preventing the incidence of POAF compared to CABG alone. This calls for further research focusing on investigating combined preventive strategies, rather than relying solely on PCD, and developing risk stratification tools to identify patients most likely to benefit from autonomic modulation.