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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Systematic review and meta-analysis: Is surgical cardiac denervation effective against postoperative atrial fibrillation?
Danyal Bakht, Maaz Amir, Fahad Saleem, Ahmed Asif, Mohammad Maheer Mubashir, Abdullah Shahid Farooq, Muhammad Zauraiz Malik, Ahmad Hassan, Kinza Bakht, Muhammad Arham, Syed Faqeer Hussain Bokhari, Muhammad Numan Awais, Muhammad Khan Buhadur Ali, Allah Dad, Muhammad Rizwan Akram
Danyal Bakht, Maaz Amir, Ahmed Asif, Mohammad Maheer Mubashir, Abdullah Shahid Farooq, Muhammad Zauraiz Malik, Ahmad Hassan, Syed Faqeer Hussain Bokhari, Muhammad Khan Buhadur Ali, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Fahad Saleem, Department of Medicine, Punjab Medical College, Faisalabad 54100, Punjab, Pakistan
Kinza Bakht, Muhammad Arham, Allah Dad, Department of Medicine, Sheikh Zayed Medical College, Rahimyar Khan 64200, Punjab, Pakistan
Muhammad Numan Awais, Department of Medicine, Shaheed Ziaur Rahman Medical College, Bogra 5800, Rājshāhi, Bangladesh
Muhammad Rizwan Akram, Department of Medicine, Bronxcare Health System, New York, NY 07008, United States
Author contributions: Bakht D, Amir M, and Saleem F conceptualized and designed the study, supervised the entire research process, and made major contributions to data analysis, interpretation, and manuscript preparation; Asif A, Mubashir MM, and Farooq AS performed the literature search, data extraction, and assisted in drafting the initial manuscript; Malik MZ and Hassan A contributed to statistical analysis, results synthesis, and provided revisions to the manuscript; Bakht K, Arham M, and Bokhari SFH assisted in verifying data accuracy, managing references, and formatting; Awais MN, Buhadur Ali MK and Dad A contributed to proofreading and minor edits; Akram MR provided senior oversight, critically reviewed the manuscript for intellectual content, and approved the final version. All authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Muhammad Numan Awais, Department of Medicine, Shaheed Ziaur Rahman Medical College, Silimpur, Bogra 5800, Rājshāhi, Bangladesh.
muhammadnumanawais433@gmail.com
Received: June 16, 2025
Revised: June 26, 2025
Accepted: August 12, 2025
Published online: September 26, 2025
Processing time: 95 Days and 16.4 Hours
BACKGROUND
Postoperative atrial fibrillation (POAF) is a complication after cardiac surgeries associated with increased morbidity and hospital stay. Surgical cardiac denervation, which reduces autonomic input to the heart, has been proposed as a good preventive against POAF. However, evidence on its effectiveness remains inconsistent.
AIM
To evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.
METHODS
This meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted across PubMed, Cochrane, ScienceDirect, and EMBASE up to April 2025 using a preformed search strategy using Medical Subject Headings terms and free-text keywords. Risk of bias assessment was done via Risk of Bias 2.0 and Risk Of Bias In Non-randomized Studies - of Interventions tools. Study analysis was performed using Review Manager version 5.4, with heterogeneity assessed via I2 values and appropriate fixed- or random-effects models applied.
RESULTS
Five studies (N = 1266) were included, with 627 patients undergoing cardiac denervation and 639 serving as controls. Denervation did not significantly reduce overall POAF [odds ratio = 0.71; 95% confidence interval (CI): 0.32-1.58; P = 0.40; I2 = 83%], but was associated with a significant reduction in persistent atrial fibrillation (odds ratio = 0.19; 95%CI: 0.10-0.36; P < 0.00001; I2 = 0%). Among secondary outcomes, only postoperative serum magnesium levels significantly reduced the denervation group (mean difference: -0.07 mmol/L; 95%CI: -0.08 to -0.06;P < 0.00001). Other outcomes, such as reoperation for bleeding, stroke/transient ischemic attack, length of hospital stay, 30-day mortality, and postoperative drainage, did not show any significant difference.
CONCLUSION
Surgical cardiac denervation does not significantly reduce overall POAF but does lower the incidence of persistent atrial fibrillation. It is also shown to decrease serum magnesium levels. Other outcomes, such as stroke, reoperation, and hospital stay, showed no significant differences.
Core Tip: This systematic review and meta-analysis assessed the effectiveness of surgical cardiac denervation in preventing postoperative atrial fibrillation after cardiac surgery. While denervation did not significantly lower the overall incidence of postoperative atrial fibrillation, it was strongly associated with a marked reduction in persistent atrial fibrillation. These findings highlight the potential role of autonomic modulation in targeting sustained arrhythmias, even though its impact on other clinical outcomes such as stroke, mortality, and hospital stay was minimal.
