Cardiovascular Disease-Specific Responses to Autonomic Denervation

Area of Science:

• Cardiovascular Surgery
• Electrophysiology
• Autonomic Nervous System

Background:

• Calcium-mediated autonomic denervation has previously suppressed postoperative atrial fibrillation (POAF) after coronary artery bypass grafting.
• The efficacy of this denervation technique in preventing POAF after other cardiac surgeries remains to be determined.

Purpose of the Study:

• To evaluate if autonomic denervation using calcium chloride (CaCl2) can prevent POAF in patients undergoing mitral or aortic valve surgery.
• To assess the impact of CaCl2 injections into atrial ganglionated plexi on POAF incidence and other postoperative outcomes.

Main Methods:

• Two single-center, randomized, double-blind, sham-controlled trials (CAP-AF2 for mitral valve surgery, CAP-AF3 for aortic valve surgery) were conducted.
• Patients received injections of either 5% CaCl2 or 0.9% NaCl (control) into the atrial ganglionated plexi during surgery.
• Primary outcome was POAF incidence within 7 days; secondary outcomes included hospital stay, AF burden, and inflammatory markers.

Main Results:

• The CAP-AF2 trial was terminated early due to a significant increase in POAF incidence in the CaCl2 group (55.13%) compared to the control group (37.80%).
• In the CAP-AF3 trial, no significant difference in POAF incidence was observed between the CaCl2 (35.59%) and NaCl (39.67%) groups.
• No significant differences in hospital stay, AF burden, antiarrhythmic therapy, or inflammatory markers were found between groups in either trial.

Conclusions:

• Calcium-mediated autonomic denervation is not universally effective in preventing POAF across different cardiac surgery types.
• The procedure showed an increased risk of POAF in mitral valve surgery, underscoring the need for disease-specific prevention strategies.
• Autonomic denervation did not impact POAF rates in aortic valve surgery patients.