Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery

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. • 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.