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Updated: May 8, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Surgical neuromodulation therapies to prevent postoperative atrial fibrillation: A meta-analysis, meta-regression,
Leo N Consoli1, Eren Cetinel2, Pawel Lajczak3
1Federal University of Bahia, Salvador, Brazil.
Background:
Postoperative atrial fibrillation (POAF) occurs frequently after cardiac surgery and is associated with increased mortality.
Objective:
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, intensive care unit stay) end points. Subgroup analysis was conducted for each technique. We compared end points using risk ratio for binary outcomes 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) end points. We conducted meta-regression for all covariates with at least 10 observations.
Results:
We included 20 trials (n = 3348): 7 studied anterior fat pad (AFP) preservation; 5, pulmonary vein isolation (PVI); 2, ganglionated plexus ablation; 1, partial cardiac denervation (PCD); and 5, epicardial injections. POAF incidence was lower in the SNMT group (risk ratio, 0.62 [0.48-0.79]; P < .001), driven by the AFP preservation, PCD, and PVI subgroups. Epicardial injections were effective only in patients undergoing coronary surgery. SNMTs also reduced hospital stay (P = .03). All meta-regression analyses were insignificant. In the trial sequential analysis, a positive effect for POAF was observed.
Conclusion:
This meta-analysis found a significant reduction in POAF incidence with implementation of AFP preservation, PCD, and PVI. Epicardial injections were effective only for patients undergoing coronary bypass.
