Ventral Cardiac Denervation to Reduce Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: A Quasi-Experimental Study
DOI:
https://doi.org/10.70749/ijbr.v3i5.3011Keywords:
Atrial fibrillation, arrhythmia, CABG surgery, cardiac denervationAbstract
Objective: To assess the effectiveness of ventral cardiac denervation (VCD) in reducing the incidence of postoperative atrial fibrillation (POAF) in patients undergoing elective coronary artery bypass grafting (CABG). Study Design: Quasi-experimental study. Place and Duration of Study: Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, for six months (July to December 2024). Methods: Ninety-eight patients undergoing elective CABG were divided into two equal groups. Group A underwent conventional CABG, while Group B underwent CABG with ventral cardiac denervation achieved by excision of epicardial fat pads surrounding the superior vena cava, ascending aorta, and aortopulmonary groove. Continuous telemetry monitoring was used for the detection of POAF. Results: In the CABG-only group, 38.8% patients had postoperative atrial fibrillation as compared with 26.5% patients in the VCD group (p = 0.18). Mean hospital stay was shorter in the VCD group (6.9 ± 1.4 days vs. 7.4 ± 1.6 days; p = 0.09). Conclusion: Ventral cardiac denervation showed a trend toward reduction in postoperative atrial fibrillation and hospital stay; however, these differences did not reach statistical significance.
Downloads
References
1. Maisel WH, Rawn JD, Stevenson WG. Atrial Fibrillation after Cardiac Surgery. Ann Intern Med. 2001 Dec 18;135(12):1061–73.
https://doi.org/10.7326/0003-4819-135-12-200112180-00010
2. Mostafa A, EL-Haddad MA, Shenoy M, Tuliani T. Atrial fibrillation post cardiac bypass surgery. Avicenna J Med. 2012;2(3):65–70. ubMed PMID: 23826549; PubMed Central PMCID: PMC3697424.
https://doi.org/10.4103/2231-0770.102280
3. Yang Z, Tiemuerniyazi X, Xu F, Wang Y, Sun Y, Yan P, et al. Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: The pCAD-POAF Randomized Clinical Trial. JAMA Cardiol. 2025 Jan 1;10(1):71.
https://doi.org/10.1001/jamacardio.2024.4639
4. Naveed D, Ullah I, Khan A, Khan MG, Ghufran MH, Shah MH, et al. Prevalence, Spectrum, and Determinants of Cardiac Arrhythmias in the Postoperative Period Following Coronary Artery Bypass Grafting (CABG): A Prospective Observational Study. Cureus. 2025 Oct 6.
https://doi.org/10.7759/cureus.93982
5. Abdelmoneim SS, Rosenberg E, Meykler M, Patel B, Reddy B, Ho J, et al. The Incidence and Natural Progression of New-Onset Postoperative Atrial Fibrillation. JACC Clin Electrophysiol. 2021 Sep;7(9):1134–44.
https://doi.org/10.1016/j.jacep.2021.02.005
6. Zafeiropoulos S, Doundoulakis I, Farmakis IT, Miyara S, Giannis D, Giannakoulas G, et al. Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery. J Am Coll Cardiol. 2022 Feb;79(7):682–94.
https://doi.org/10.1016/j.jacc.2021.12.010
7. Halonen J, Kärkkäinen J, Jäntti H, Martikainen T, Valtola A, Ellam S, et al. Prevention of Atrial Fibrillation After Cardiac Surgery: A Review of Literature and Comparison of Different Treatment Modalities. Cardiol Rev. 2024 May;32(3):248–56.
https://doi.org/10.1097/CRD.0000000000000499
8. Arnulf G. De la section du plexus préaortique: justification et technique. Presse Med. 1939;94:1635–41.
9. Grondin CM, Limet R. Sympathetic Denervation in Association with Coronary Artery Grafting in Patients with Prinzmetal’s Angina. Ann Thorac Surg. 1977 Feb;23(2):111–7.
https://doi.org/10.1016/S0003-4975(10)64081-7
10. Clark DA, Quint RA, Mitchell RL, Angell WW. Coronary artery spasm. J Thorac Cardiovasc Surg. 1977 Mar;73(3):332–9.
https://doi.org/10.1016/S0022-5223(19)39910-6
11. Melo J, Voigt P, Sonmez B, Ferreira M, Abecasis M, Rebocho M, et al. Ventral cardiac denervation reduces the incidence of atrial fibrillation after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2004 Feb 1;127(2):511–6.
https://doi.org/10.1016/S0022-5223(03)01283-2
12. Alex J, Guvendik L. Evaluation of Ventral Cardiac Denervation As a Prophylaxis Against Atrial Fibrillation After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2005 Feb;79(2):517–20.
https://doi.org/10.1016/j.athoracsur.2004.08.011
13. Shah S, Chahil V, Battisha A, Haq S, Kalra DK. Postoperative Atrial Fibrillation: A Review. Biomedicines. 2024 Sep 1;12(9):1968.
https://doi.org/10.3390/biomedicines12091968
14. Kazemi B, Ahmadzadeh A, Safaei N, Jodati A, Sohrabi B, Afrasiabi A. Influence of anterior periaortic fat pad excision on incidence of postoperative atrial fibrillation. Eur J Cardiothorac Surg. 2011 Apr;S1010794011002338.
https://doi.org/10.1016/j.ejcts.2011.02.034
15. Gordan R, Gwathmey JK, Xie LH. Autonomic and endocrine control of cardiovascular function. World J Cardiol. 2015 Apr 26;7(4):204–14. PubMed PMID: 25914789; PubMed Central PMCID: PMC4404375.
https://doi.org/10.4330/wjc.v7.i4.204
16. Giannino G, Braia V, Griffith Brookles C, Giacobbe F, D’Ascenzo F, Angelini F, et al. The Intrinsic Cardiac Nervous System: From Pathophysiology to Therapeutic Implications. Biology. 2024 Feb 7;13(2):105.
https://doi.org/10.3390/biology13020105
17. Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment. Front Cardiovasc Med. 2023;10:1327387. PubMed PMID: 38239878; PubMed Central PMCID: PMC10794613.
https://doi.org/10.3389/fcvm.2023.1327387
18. Scridon A. Autonomic imbalance and atrial ectopic activity—a pathophysiological and clinical view. Front Physiol. 2022 Dec 2;13:1058427.
https://doi.org/10.3389/fphys.2022.1058427
19. Pan WT, Ji M huo, Ma D, Yang JJ. Effect of perioperative autonomic nervous system imbalance on surgical outcomes: a systematic review. Br J Anaesth. 2025 Sep;135(3):608–22.
https://doi.org/10.1016/j.bja.2025.06.004
20. Wink J, Van Delft R, Notenboom RGE, Wouters PF, DeRuiter MC, Plevier JWM, et al. Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation. Auton Neurosci. 2020 Sep;227:102674.
https://doi.org/10.1016/j.autneu.2020.102674
21. Pather N, Partab P, Singh B, Satyapal KS. The sympathetic contributions to the cardiac plexus. Surg Radiol Anat. 2003 Aug 1;25(3–4):210–5.
https://doi.org/10.1007/s00276-003-0113-2
22. Stavrakis S, Kulkarni K, Singh JP, Katritsis DG, Armoundas AA. Autonomic Modulation of Cardiac Arrhythmias. JACC Clin Electrophysiol. 2020 May;6(5):467–83.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
