pCAD-POAF
Trial question
What is the role of partial cardiac denervation for the prevention of postoperative AF in patients undergoing CABG?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
82.0% female
18.0% male
N = 430
430 patients (351 female, 79 male).
Inclusion criteria: adult patients scheduled for isolated CABG.
Key exclusion criteria: age < 18 years; urgent CABG; prior cardiac surgery history; concurrent cardiac surgery, LV reconstruction, valvular surgery, or surgery for aortic diseases; critical condition requiring mechanical or pharmaceutical sustainment before CABG; history of AF.
Interventions
N=215 partial cardiac denervation plus CABG (CABG plus partial cardiac denervation achieved by cutting off the ligament of Marshall and resecting the fat pad along the Waterston groove).
N=215 CABG only (CABG without an additional surgical procedure).
Primary outcome
Rate of postoperative atrial fibrillation in 6 days
18.1%
31.6%
31.6 %
23.7 %
15.8 %
7.9 %
0.0 %
Partial cardiac denervation plus
CABG
CABG
only
Significant
decrease ▼
NNT = 7
Significant decrease in the rate of postoperative AF in 6 days (18.1% vs. 31.6%; RR 0.57, 95% CI 0.41 to 0.81).
Secondary outcomes
No significant difference in perioperative blood transfusion (15.4% vs. 20.5%; ARD -5.1, 95% CI -12.37 to 2.17).
No significant difference in reoperation for postoperative bleeding (0% vs. 0.9%; ARD -0.9, 95% CI -3.46 to 1.66).
No significant difference in mean postoperative length of hospitalization (6.8 days vs. 7.3 days; AD -0.5 days, 95% CI -1.08 to 0.08).
Safety outcomes
No significant difference in major adverse cardiovascular and cerebrovascular events.
Conclusion
In adult patients scheduled for isolated CABG, partial cardiac denervation plus CABG was superior to CABG only with respect to the rate of postoperative AF in 6 days.
Reference
Ziang Yang, Xieraili Tiemuerniyazi, Fei Xu et al. Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: The pCAD-POAF Randomized Clinical Trial. JAMA Cardiol. 2025 Jan 1;10(1):71-77.
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