Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery: JACC Review Topic of the Week

• Published in: Journal of the American College of Cardiology 2022-02, Vol.79 (7), p.682-694
• Main Authors: Zafeiropoulos, Stefanos, Doundoulakis, Ioannis, Farmakis, Ioannis T, Miyara, Santiago, Giannis, Dimitrios, Giannakoulas, George, Tsiachris, Dimitris, Mitra, Raman, Skipitaris, Nicholas T, Mountantonakis, Stavros E, Stavrakis, Stavros, Zanos, Stavros
• Format: Article
• Language: English
• Subjects: Atrial Fibrillation - etiology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Autonomic Nerve Block - methods; Autonomic Nerve Block - trends; Autonomic Nervous System - physiopathology; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - trends; Humans; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - therapy; Radiofrequency Ablation - methods; Radiofrequency Ablation - trends; Vagus Nerve Stimulation - methods; Vagus Nerve Stimulation - trends
• ISSN: 1558-3597
• DOI: 10.1016/j.jacc.2021.12.010

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.