Prophylactic ventral cardiac denervation: Does it reduce incidence of atrial fibrillation after coronary artery bypass grafting?

Omran, Abbas Salehi; Karimi, Abbasali; Ahmadi, Hossein; Yazdanifard, Parin; Fahtollahi, Mahmood Sheikh; Tazik, Mokhtar

doi:10.1016/j.jtcvs.2009.12.024

Cited by 13 publications

(4 citation statements)

References 8 publications

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“…The estimated odds ratios, which show that patients with raised platelet counts, CRP levels, neutrophil scores, or SII had a considerably higher chance of having AF after surgery, further support the association. These results are consistent with earlier studies that link inflammation to the development and maintenance of AF [5][6][7][8][9][10][11][12][13].…”

Section: Discussionsupporting

confidence: 93%

“…Heart surgery-induced inflammation is caused by a series of inflammatory mediators, including leukocytes and cytokines, which can cause both localized and systemic inflammation [7]. C-reactive protein (CRP) is a nonspecific acute-phase reactant that has attracted a lot of interest as one of the major markers linked to this reaction [8]. In a number of clinical contexts, elevated CRP levels, a sign of greater systemic inflammation, have been linked to a higher risk of AF [9,10].…”

Section: Introductionmentioning

confidence: 99%

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The Significance of Systemic Inflammatory Markers in ‘New-Onset Atrial Fibrillation’ Following Cardiac Surgeries

Mittal,

Bhushan,

Jhajhria

et al. 2024

Cureus

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Postoperative atrial fibrillation (AF) is a known complication of postoperative morbidity and mortality in cardiac surgery. The purpose of this retrospective study was to look into the association between the incidence of new-onset AF in patients undergoing cardiac surgery and preoperative systemic inflammatory markers.Patients were divided into two groups (Group A: new-onset AF, Group B: no AF) depending on the occurrence of AF in the postoperative period, and a retrospective analysis was performed to look for the association between the incidence of new-onset AF and levels of systemic inflammatory markers. Five hundred patients were enrolled in the study, and the duration was three years. One-hundred and fifty out of 500 patients who underwent cardiac surgeries between 2020 and 2023 had higher levels of preoperative inflammatory markers. The systemic immune inflammation index (SII), neutrophil scores, platelet counts, and C-reactive protein (CRP) levels were examined.Compared to patients without AF (Group B), those who developed AF (Group A) had significantly higher mean levels of CRP (6.2 ± 1.8 mg/L), platelet count (320 ± 50 x10 9 /L), neutrophil scores (4.6 ± 0.9), and SII (650 ± 120) (p<0.05 for all). Higher thresholds of these inflammatory markers were related to a notable increase in the prevalence of AF, with odds ratios showing significantly higher risks associated with raised marker levels.In summary, there was a significant correlation found between an increased risk of new-onset AF after surgery and elevated preoperative inflammatory markers, such as CRP levels, platelet counts, neutrophil scores, and SII. These findings could be used as prognostic markers to identify patients who are more likely to experience postoperative AF. Further prospective studies will be required to analyze their predictive value. Limitations of our study include the relatively small sample size, potential bias from singleinstitutional data, and the retrospective nature of the study design.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The Significance of Systemic Inflammatory Markers in ‘New-Onset Atrial Fibrillation’ Following Cardiac Surgeries

Mittal,

Bhushan,

Jhajhria

et al. 2024

Cureus

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“…Other studies failed to show the benefit of cardiac denervation or found even an increase in POAF. 107–109 These findings, however, do not exclude a role for sympathetic activation in the arrhythmia substrate, as both sympathetic and parasympathetic activation alter atrial refractoriness. 109,110 Hogue et al .…”

Section: Mechanisms Based On Acute Factorsmentioning

confidence: 96%

“…107–109 These findings, however, do not exclude a role for sympathetic activation in the arrhythmia substrate, as both sympathetic and parasympathetic activation alter atrial refractoriness. 109,110 Hogue et al . 103 detected a higher HRV in some patients, but a lower HRV in others in the hour before onset of POAF, suggesting the possibility of divergent autonomic conditions shortly before onset of the arrhythmia.…”

Section: Mechanisms Based On Acute Factorsmentioning

confidence: 96%

Post-operative atrial fibrillation: a maze of mechanisms

Maesen¹,

Nijs²,

Maessen³

et al. 2011

Europace

370

299

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Post-operative atrial fibrillation (POAF) is one of the most frequent complications of cardiac surgery and an important predictor of patient morbidity as well as of prolonged hospitalization. It significantly increases costs for hospitalization. Insights into the pathophysiological factors causing POAF have been provided by both experimental and clinical investigations and show that POAF is ‘multi-factorial’. Facilitating factors in the mechanism of the arrhythmia can be classified as acute factors caused by the surgical intervention and chronic factors related to structural heart disease and ageing of the heart. Furthermore, some proarrhythmic mechanisms specifically occur in the setting of POAF. For example, inflammation and beta-adrenergic activation have been shown to play a prominent role in POAF, while these mechanisms are less important in non-surgical AF. More recently, it has been shown that atrial fibrosis and the presence of an electrophysiological substrate capable of maintaining AF also promote the arrhythmia, indicating that POAF has some proarrhythmic mechanisms in common with other forms of AF. The clinical setting of POAF offers numerous opportunities to study its mechanisms. During cardiac surgery, biopsies can be taken and detailed electrophysiological measurements can be performed. Furthermore, the specific time course of POAF, with the delayed onset and the transient character of the arrhythmia, also provides important insight into its mechanisms.This review discusses the mechanistic interaction between predisposing factors and the electrophysiological mechanisms resulting in POAF and their therapeutic implications.

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Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting

Yang,

Tiemuerniyazi,

et al. 2024

JAMA Cardiol

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ImportanceEfficient approaches to prevent postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) are still needed.ObjectiveTo investigate whether partial cardiac denervation, achieved by cutting off the ligament of Marshall (LOM) and resecting the fat pad along the Waterston groove, can reduce the risk of POAF following CABG.Design, Setting and ParticipantsThis single-center, randomized clinical trial enrolled adult patients scheduled for isolated CABG in China. Enrollment was from August 15, 2022, to December 13, 2023; follow-up visits were 30 days after discharge.InterventionsParticipants were randomized into the intervention group (CABG plus partial cardiac denervation) and the control group (CABG only) in a 1:1 pattern. All participants were continuously monitored for the incidence of POAF until day 6 after the operation.Main outcome and MeasuresThe primary end point was the incidence of POAF in 6 days, defined as a supraventricular arrhythmia lasting for more than 30 seconds.ResultsThe trial enrolled 430 patients (79 [18.4%] female; mean [SD] age, 61.9 [7.8] years). Compared with the control group, the 6-day incidence of POAF was significantly lower in the intervention group (18.1% vs 31.6%; P = .001; risk ratio, 0.57 [95% CI, 0.41-0.81]). To further support these results, a sensitivity analysis performed with Kaplan-Meier survival curves also showed a significant reduction in the occurrence of POAF in the intervention group (hazard ratio, 0.53 [95% CI, 0.36-0.79]; P = .002). Safety assessments showed no difference between the 2 groups, while postoperative medical cost was reduced in the intervention group.Conclusions and RelevanceThis randomized clinical trial found that partial cardiac denervation was an effective procedure to reduce the occurrence of POAF after isolated CABG without additional postoperative complications. These results suggest that partial cardiac denervation may be a good option for cardiac surgeons to consider for preventing POAF after CABG.Trial RegistrationClinicalTrials.gov Identifier: NCT05009914

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Prophylactic ventral cardiac denervation: Does it reduce incidence of atrial fibrillation after coronary artery bypass grafting?

Cited by 13 publications

References 8 publications

The Significance of Systemic Inflammatory Markers in ‘New-Onset Atrial Fibrillation’ Following Cardiac Surgeries

The Significance of Systemic Inflammatory Markers in ‘New-Onset Atrial Fibrillation’ Following Cardiac Surgeries

Post-operative atrial fibrillation: a maze of mechanisms

Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting

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