The Present and Future
JACC Review Topic of the Week
Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery: JACC Review Topic of the Week

https://doi.org/10.1016/j.jacc.2021.12.010Get rights and content
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Highlights

  • The autonomic nervous system has been implicated in the occurrence of AF after cardiac surgery.

  • Autonomic neuromodulation may reduce the incidence and burden of postoperative AF and the length of hospital stay following cardiac surgery.

  • Potentially effective methods of autonomic neuromodulation include low-level vagus nerve stimulation and epicardial neural blockade.

Abstract

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.

Key Words

atrial fibrillation
autonomous nervous system
neuromodulation
vagus nerve

Abbreviations and Acronyms

AF
atrial fibrillation
ANMT
autonomic neuromodulation therapy
ANS
autonomous nervous system
CABG
coronary artery bypass grafting
GP
ganglionated plexus
ICU
intensive care unit
LL-VNS
low-level vagus nerve stimulation
LOS
length of stay
MD
mean difference
POAF
postoperative atrial fibrillation
PVI
pulmonary vein isolation
RCT
randomized controlled trial

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