Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: The pCAD-POAF Randomized Clinical Trial.

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JAMA cardiology Pub Date : 2024-11-17 DOI:10.1001/jamacardio.2024.4639

Ziang Yang, Xieraili Tiemuerniyazi, Fei Xu, Yang Wang, Yang Sun, Peng Yan, Liangxin Tian, Chao Han, Yan Zhang, Shiwei Pan, Zhan Hu, Xi Li, Wei Zhao, Wei Feng

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Abstract

Importance: Efficient approaches to prevent postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) are still needed.

Objective: To investigate whether partial cardiac denervation, achieved by cutting off the ligament of Marshall (LOM) and resecting the fat pad along the Waterston groove, can reduce the risk of POAF following CABG.

Design, setting and participants: This single-center, randomized clinical trial enrolled adult patients scheduled for isolated CABG in China. Enrollment was from August 15, 2022, to December 13, 2023; follow-up visits were 30 days after discharge.

Interventions: Participants were randomized into the intervention group (CABG plus partial cardiac denervation) and the control group (CABG only) in a 1:1 pattern. All participants were continuously monitored for the incidence of POAF until day 6 after the operation.

Main outcome and measures: The primary end point was the incidence of POAF in 6 days, defined as a supraventricular arrhythmia lasting for more than 30 seconds.

Results: The trial enrolled 430 patients (79 [18.4%] female; mean [SD] age, 61.9 [7.8] years). Compared with the control group, the 6-day incidence of POAF was significantly lower in the intervention group (18.1% vs 31.6%; P = .001; risk ratio, 0.57 [95% CI, 0.41-0.81]). To further support these results, a sensitivity analysis performed with Kaplan-Meier survival curves also showed a significant reduction in the occurrence of POAF in the intervention group (hazard ratio, 0.53 [95% CI, 0.36-0.79]; P = .002). Safety assessments showed no difference between the 2 groups, while postoperative medical cost was reduced in the intervention group.

Conclusions and relevance: This randomized clinical trial found that partial cardiac denervation was an effective procedure to reduce the occurrence of POAF after isolated CABG without additional postoperative complications. These results suggest that partial cardiac denervation may be a good option for cardiac surgeons to consider for preventing POAF after CABG.

Trial registration: ClinicalTrials.gov Identifier: NCT05009914.

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部分心脏去神经化预防冠状动脉旁路移植术后心房颤动：pCAD-POAF 随机临床试验。

重要性：目前仍需要有效的方法来预防冠状动脉旁路移植术（CABG）术后心房颤动（POAF）：目的：研究通过切断马歇尔韧带（LOM）并沿沃特斯顿沟切除脂肪垫来实现部分心脏去神经化是否能降低冠状动脉旁路移植术后发生心房颤动的风险：这项单中心随机临床试验招募了中国计划接受孤立CABG的成年患者。入组时间为 2022 年 8 月 15 日至 2023 年 12 月 13 日；随访时间为出院后 30 天：干预措施：以 1:1 的模式将参与者随机分为干预组（CABG 加部分心脏去神经）和对照组（仅 CABG）。所有参与者在术后第6天之前均接受POAF发生率的持续监测：主要终点是 6 天内 POAF 的发生率，定义为持续 30 秒以上的室上性心律失常：试验共招募了 430 名患者（女性 79 [18.4%]；平均 [SD] 年龄 61.9 [7.8] 岁）。与对照组相比，干预组的 POAF 6 天发病率明显降低（18.1% vs 31.6%；P = .001；风险比为 0.57 [95% CI, 0.41-0.81]）。为了进一步支持这些结果，利用卡普兰-梅耶生存曲线进行的敏感性分析也显示，干预组的 POAF 发生率显著降低（危险比为 0.53 [95% CI, 0.36-0.79]; P = .002）。安全性评估显示两组之间没有差异，而干预组的术后医疗费用有所降低：这项随机临床试验发现，心脏部分去神经化手术能有效减少孤立的心血管成形术后 POAF 的发生，且不会增加术后并发症。这些结果表明，对于心脏外科医生来说，部分心脏去神经化可能是预防 CABG 术后 POAF 的一个不错选择：试验注册：ClinicalTrials.gov Identifier：试验注册：ClinicalTrials.gov Identifier：NCT05009914。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

45.80

自引率

1.70%

发文量

264

期刊介绍： JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.