Stellate Ganglion Block Reduces the Incidence of Postoperative Atrial Fibrillation After Coronary Artery Bypass
Shunping Tian1, Chao Chen2, Wei Liang3
1Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China.
Background:
Postoperative atrial fibrillation (POAF) is associated with sympathetic overactivity. Stellate ganglion is a potential target for intervention.
Objectives:
The aim of this study was to examine the efficacy of preemptive left stellate ganglion block (SGB) in reducing POAF in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
Methods:
Patients were randomized to the SGB group or the control group. The primary endpoint was the incidence of POAF within 5 days postoperatively. Secondary endpoints included POAF-associated characteristics and recovery indicators.
Results:
A total of 124 patients underwent initial randomization, with 108 in modified intention-to-treat and 98 in per-protocol analysis. In modified intention-to-treat analysis, POAF occurred in 18.5% of the SGB group and 44.4% of the control group (OR: 0.288; 95% CI: 0.106-0.731; P = 0.007). Per-protocol analysis yielded consistent results. SGB group showed significantly lower POAF burden, shorter duration of first POAF episode, fewer POAF episodes and antiarrhythmic treatments, decreased C-reactive protein, interleukin-6, high-sensitivity cardiac troponin T, and creatine kinase-MB on certain postoperative time points, and decreased postoperative hospitalization than the control group (all P < 0.05). Exploratory subgroup analyses suggested that the association between SGB pretreatment and lower POAF incidence was more pronounced among patients without diabetes (OR: 0.10; 95% CI: 0.019-0.480; P = 0.004) and those at lower baseline risk of POAF (OR: 0.10; 95% CI: 0.005-0.642; P = 0.040).
Conclusions:
In patients undergoing coronary artery bypass grafting with cardiopulmonary bypass, preemptive left SGB was associated with a reduced incidence of POAF within 5 postoperative days. Exploratory subgroup analyses suggested a potentially greater association among patients without diabetes and those at lower risk of POAF.
