Abstract Body (Do not enter title and authors here): Introduction: 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.

Objectives: This systematic review and meta-analysis evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.

Methods: This meta-analysis adhered to PRISMA guidelines. A literature search was conducted across PubMed, Cochrane, ScienceDirect, and Embase up to April 2025 using a preformed search strategy using MeSH terms and free-text keywords. Risk of bias assessment was done via Rob 2.0 and ROBINS-I tools. Study analysis was performed using RevMan 5.4, with heterogeneity assessed via I2 values and appropriate fixed- or random-effects models applied.

Results: Five studies (n = 1,266) were included, with 627 patients undergoing cardiac denervation and 639 serving as controls. Denervation did not significantly reduce overall postoperative atrial fibrillation (OR 0.71; 95% CI, 0.32–1.58; p = 0.40; I2 = 83%) but was associated with a significant reduction in persistent atrial fibrillation (OR 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 (MD −0.07 mmol/L; 95% CI, −0.08 to −0.06; p < 0.00001). Other outcomes, such as reoperation for bleeding, stroke/TIA, length of hospital stay, 30-day mortality, and postoperative drainage, did not show any significant difference. Risk of bias assessment showed varied quality across studies, with one RCT rated low risk, one with some concerns, and one with high risk; non-randomized studies showed moderate risk.

Conclusion: Surgical cardiac denervation does not significantly reduce overall postoperative atrial fibrillation 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.