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

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. (J Am Coll Cardiol 2022;79:682-694) (c) 2022 by the American College of Cardiology Foundation.

Automated summary

This review critically appraised the current evidence on autonomic neuromodulation therapies (ANMTs) for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. The meta-analysis found that ANMTs can reduce the incidence and burden of POAF, shorten length of stay, and decrease inflammatory response. These findings provide a foundation for future larger and comparative trials of ANMTs.