Surgical Neuromodulation Therapies to Prevent Postoperative Atrial Fibrillation: A Meta-Analysis, Meta Regression and Trial Sequential Analysis of Randomized Controlled Trials.
Leo N Consoli, Eren Cetinel, Pawel Lajczak, Ilias G Koziakas, Mir Wajid Majeed, Prajna Wijaya, Issa Salha, George Samanidis
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引用次数: 0
Abstract
Background: Postoperative atrial fibrillation (POAF) occurs frequently after cardiac surgery and is associated with increased mortality.
Objectives: Surgical neuromodulation therapies (SNMTs) have been explored as a preventive strategy, but their efficacy and safety remain uncertain.
Methods: We searched PubMed, Embase and the Cochrane library for eligible randomized controlled trials. Meta-analysis was performed for primary (POAF) and secondary (hospital stay; complications; atrial fibrillation at 1 year; operation time; POAF burden; ICU stay) endpoints. Subgroup analysis was conducted for each technique. We compared endpoints using risk ratio (RR) for binary and mean difference for continuous outcomes. We calculated 95% confidence intervals for all outcomes. We carried out a trial sequential analysis for primary (POAF) and secondary (hospital stay; complications) endpoints. We conducted meta-regression for all covariates with at least 10 observations.
Results: We included 20 trials (n=3348). Seven studied anterior fat pad (AFP) preservation, 5 pulmonary vein isolation (PVI), 2 ganglionic plexus (GP) ablation, 1 partial cardiac denervation (PCD) and 5 assessed epicardial injections. POAF incidence was lower in the SNMT group (RR 0.62 (0.48; 0.79), p < 0.001), driven by the AFP preservation, PCD and PVI subgroups. Epicardial injections were only effective in patients undergoing coronary surgery. SNMTs also reduced hospital stay (p=0.03). All meta-regression analyses were insignificant. In the trial sequential analysis, a positive effect for POAF was observed.
Conclusions: This meta-analysis found a significant reduction in POAF incidence with implementation of AFP preservation, PCD and PVI. Epicardial injections were only effective for patients undergoing coronary bypass.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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