Systematic review and meta-analysis: Is surgical cardiac denervation effective against postoperative atrial fibrillation?

Abstract

Background: Postoperative atrial fibrillation (POAF) is a complication after cardiac surgeries associated with increased morbidity and hospital stay. Surgical cardiac denervation, which reduces autonomic input to the heart, has been proposed as a good preventive against POAF. However, evidence on its effectiveness remains inconsistent.

Aim: To evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.

Methods: This meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted across PubMed, Cochrane, ScienceDirect, and EMBASE up to April 2025 using a preformed search strategy using Medical Subject Headings terms and free-text keywords. Risk of bias assessment was done via Risk of Bias 2.0 and Risk Of Bias In Non-randomized Studies - of Interventions tools. Study analysis was performed using Review Manager version 5.4, with heterogeneity assessed via I ² values and appropriate fixed- or random-effects models applied.

Results: Five studies (N = 1266) were included, with 627 patients undergoing cardiac denervation and 639 serving as controls. Denervation did not significantly reduce overall POAF [odds ratio = 0.71; 95% confidence interval (CI): 0.32-1.58; P = 0.40; I ² = 83%], but was associated with a significant reduction in persistent atrial fibrillation (odds ratio = 0.19; 95%CI: 0.10-0.36; P < 0.00001; I ² = 0%). Among secondary outcomes, only postoperative serum magnesium levels significantly reduced the denervation group (mean difference: -0.07 mmol/L; 95%CI: -0.08 to -0.06; P < 0.00001). Other outcomes, such as reoperation for bleeding, stroke/transient ischemic attack, length of hospital stay, 30-day mortality, and postoperative drainage, did not show any significant difference.

Conclusion: Surgical cardiac denervation does not significantly reduce overall POAF but does lower the incidence of persistent atrial fibrillation. It is also shown to decrease serum magnesium levels. Other outcomes, such as stroke, reoperation, and hospital stay, showed no significant differences.