Dexmedetomidine Reduces Atrial Fibrillation After Adult Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials
- 25 Downloads
Dexmedetomidine has been shown to have antiarrhythmic effects by exhibiting sympatholytic properties and activating the vagus nerve in preclinical studies. Results from clinical trials of dexmedetomidine on atrial fibrillation (AF) following adult cardiac surgery are controversial.
Materials and methods
We searched EMBASE, PubMed and Cochrane CENTRAL databases for randomized controlled trials (RCTs) comparing the antiarrhythmic effect of dexmedetomidine versus placebo or other anesthetic drugs in adult patients undergoing cardiac surgery. The primary outcome was the incidence of AF. The secondary outcomes were ventricular arrhythmias [ventricular fibrillation (VF), ventricular tachycardia (VT)], mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay, and hospital length of stay, and all-cause mortality.
Thirteen trials with a total of 1684 study patients were selected. Compared with controls, dexmedetomidine significantly reduced the incidence of postoperative AF [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.58–0.97; P = 0.03] and VT (OR 0.23; 95% CI 0.11–0.48; P < 0.0001). No significant difference for the incidence of VF existed (OR 0.80; 95% CI 0.21–3.03; P = 0.74). There was no significant difference between groups in MV duration [weighted mean difference (WMD) − 0.10; 95% CI − 0.42 to 0.21; P = 0.52], postoperative ICU stay (WMD − 0.49; 95% CI − 2.64 to 1.66; P = 0.65), hospital stay (WMD − 0.01; 95% CI − 0.16 to 0.13; P = 0.88) and mortality (OR 0.59; 95% CI 0.15–2.37; P = 0.46).
Perioperative administration of dexmedetomidine in adult patients undergoing cardiac surgery reduced the incidence of postoperative AF and VT. But there was no significant difference in incidence of VF, MV duration, ICU stay, hospital stay and mortality.
Study design: YL and WC; data acquisition: LZ and JZ; data analyses/interpretation: YL, FPL and SZW; supervision or mentorship: WC. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. YL and WC take responsibility that this study has been reported honestly, accurately, and transparently. All authors approved the final manuscript.
Compliance with Ethical Standards
No external funding was used in the preparation of this article.
Conflict of Interest
The authors, Yang Liu, Lei Zhang, Suozhu Wang, Feiping Lu, Jie Zhen and Wei Chen, declare that they have no potential conflicts of interest that might be relevant to the contents of this article.
- 12.Balkanay OO, Goksedef D, Omeroglu SN, Ipek G. The dose-related effects of dexmedetomidine on renal functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting: a randomized, triple-blind, placebo-controlled study. Interact Cardiovasc Thorac Surg. 2015;20(2):209–14.PubMedCrossRefPubMedCentralGoogle Scholar
- 15.Goksedef D, et al. The effects of dexmedetomidine infusion on renal functions after coronary artery bypass graft surgery: a randomized, double-blind, placebo-controlled study. Turk J Thoracic Cardiovasc Surg. 2013;21(3):8.Google Scholar
- 16.Shehabi Y, Grant P, Wolfenden H, Hammond N, Bass F, Campbell M, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology. 2009;111(5):1075–84.PubMedCrossRefPubMedCentralGoogle Scholar
- 20.Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ (Clin Res Ed). 2015;2(350):g7647.Google Scholar
- 22.Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter study of perioperative ischemia research group. JAMA. 1996;276(4):300–6.PubMedCrossRefPubMedCentralGoogle Scholar
- 24.Bradley D, Creswell LL, Hogue CW Jr, Epstein AE, Prystowsky EN, Daoud EG. Pharmacologic prophylaxis: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005;128(2 Suppl):39s–47s.PubMedCrossRefPubMedCentralGoogle Scholar
- 36.FF. C, HT. Z, X. F. Role of dexmedetomidine in the perioperative period of patients undergoing coronary artery bypass graft surgery: a meta-analysis. Med J Chin People’s Liberation Army. 2014;39(12):981–6.Google Scholar
- 38.Yang YF, Peng K, Liu H, Meng XW, Zhang JJ, Ji FH. Dexmedetomidine preconditioning for myocardial protection in ischaemia-reperfusion injury in rats by downregulation of the high mobility group box 1-toll-like receptor 4-nuclear factor kappaB signalling pathway. Clin Exp Pharmacol Physiol. 2017;44(3):353–61.PubMedCrossRefPubMedCentralGoogle Scholar
- 42.Erb TO, Kanter RJ, Hall JM, Gan TJ, Kern FH, Schulman SR. Comparison of electrophysiologic effects of propofol and isoflurane-based anesthetics in children undergoing radiofrequency catheter ablation for supraventricular tachycardia. Anesthesiology. 2002;96(6):1386–94.PubMedCrossRefPubMedCentralGoogle Scholar
- 44.Owczuk R, Wujtewicz MA, Sawicka W, Polak-Krzeminska A, Suszynska-Mosiewicz A, Raczynska K, et al. Effect of anaesthetic agents on P-wave dispersion on the electrocardiogram: comparison of propofol and desflurane. Clin Exp Pharmacol Physiol. 2008;35(9):1071–6.PubMedCrossRefPubMedCentralGoogle Scholar