Advertisement

Dexmedetomidine Reduces Atrial Fibrillation After Adult Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

  • Yang Liu
  • Lei Zhang
  • Suozhu Wang
  • Feiping Lu
  • Jie Zhen
  • Wei ChenEmail author
Original Research Article
  • 25 Downloads

Abstract

Background

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.

Results

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).

Conclusions

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.

Notes

Authors contributions

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

Funding

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.

Reference

  1. 1.
    Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardio-thoracic Surg. 2017;52(4):665–72.CrossRefGoogle Scholar
  2. 2.
    Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997;226(4):501–11 (discussion 11–3).PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291(14):1720–9.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Alawami M, Chatfield A, Ghashi R, Walker L. Atrial fibrillation after cardiac surgery: prevention and management: the Australasian experience. J Saudi Heart Assoc. 2018;30(1):40–6.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Zhang X, Zhao X, Wang Y. Dexmedetomidine: a review of applications for cardiac surgery during perioperative period. J Anesth. 2015;29(1):102–11.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Liu X, Zhang K, Wang W, Xie G, Fang X. Dexmedetomidine sedation reduces atrial fibrillation after cardiac surgery compared to propofol: a randomized controlled trial. Critical Care (Lond Engl). 2016;20(1):298.CrossRefGoogle Scholar
  7. 7.
    Turan A, Bashour CA, You J, Kirkova Y, Kurz A, Sessler DI, et al. Dexmedetomidine sedation after cardiac surgery decreases atrial arrhythmias. J Clin Anesth. 2014;26(8):634–42.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Soltani G, Jahanbakhsh S, Tashnizi MA, Fathi M, Amini S, Zirak N, et al. Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: a randomized clinical trial. Electron Physician. 2017;9(10):5578–87.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Liu X, Zhang K, Wang W, Xie G, Cheng B, Wang Y, et al. Dexmedetomidine versus propofol sedation improves sublingual microcirculation after cardiac surgery: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2016;30(6):1509–15.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Djaiani G, Silverton N, Fedorko L, Carroll J, Styra R, Rao V, et al. Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery: a randomized controlled trial. Anesthesiology. 2016;124(2):362–8.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Karaman Y, Abud B, Tekgul ZT, Cakmak M, Yildiz M, Gonullu M. Effects of dexmedetomidine and propofol on sedation in patients after coronary artery bypass graft surgery in a fast-track recovery room setting. J Anesth. 2015;29(4):522–8.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 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
  13. 13.
    Park JB, Bang SH, Chee HK, Kim JS, Lee SA, Shin JK. Efficacy and safety of dexmedetomidine for postoperative delirium in adult cardiac surgery on cardiopulmonary bypass. Korean J Thorac Cardiovasc Surg. 2014;47(3):249–54.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Ren J, Zhang H, Huang L, Liu Y, Liu F, Dong Z. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery. Exp Ther Med. 2013;6(2):497–502.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 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. 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
  17. 17.
    Corbett SM, Rebuck JA, Greene CM, Callas PW, Neale BW, Healey MA, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med. 2005;33(5):940–5.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Herr DL, Sum-Ping ST, England M. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth. 2003;17(5):576–84.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Jalonen J, Hynynen M, Kuitunen A, Heikkila H, Perttila J, Salmenpera M, et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997;86(2):331–45.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 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
  21. 21.
    Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;20(5):13.CrossRefGoogle Scholar
  22. 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
  23. 23.
    Banach M, Goch A, Misztal M, Rysz J, Zaslonka J, Goch JH, et al. Relation between postoperative mortality and atrial fibrillation before surgical revascularization–3-year follow-up. Thorac Cardiovasc Surg. 2008;56(1):20–3.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 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
  25. 25.
    Kamibayashi T, Hayashi Y, Mammoto T, Yamatodani A, Sumikawa K, Yoshiya I. Role of the vagus nerve in the antidysrhythmic effect of dexmedetomidine on halothane/epinephrine dysrhythmias in dogs. Anesthesiology. 1995;83(5):992–9.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Fayed NA, Sayed EI, Saleh SM, Ehsan NA, Elfert AY. Effect of dexmedetomidine on hepatic ischemia-reperfusion injury in the setting of adult living donor liver transplantation. Clin Transplant. 2016;30(4):470–82.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Chen S, Hua F, Lu J, Jiang Y, Tang Y, Tao L, et al. Effect of dexmedetomidine on myocardial ischemia-reperfusion injury. Int J Clin Exp Med. 2015;8(11):21166–72.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Khajuria A, Tay C, Shi J, Zhao H, Ma D. Anesthetics attenuate ischemia-reperfusion induced renal injury: effects and mechanisms. Acta Anaesthesiol Taiwanica. 2014;52(4):176–84.CrossRefGoogle Scholar
  29. 29.
    Cai Y, Xu H, Yan J, Zhang L, Lu Y. Molecular targets and mechanism of action of dexmedetomidine in treatment of ischemia/reperfusion injury. Mol Med Rep. 2014;9(5):1542–50.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Bell MT, Puskas F, Bennett DT, Herson PS, Quillinan N, Fullerton DA, et al. Dexmedetomidine, an alpha-2a adrenergic agonist, promotes ischemic tolerance in a murine model of spinal cord ischemia-reperfusion. J Thorac Cardiovasc Surg. 2014;147(1):500–6.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Ueki M, Kawasaki T, Habe K, Hamada K, Kawasaki C, Sata T. The effects of dexmedetomidine on inflammatory mediators after cardiopulmonary bypass. Anaesthesia. 2014;69(7):693–700.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Xiang H, Hu B, Li Z, Li J. Dexmedetomidine controls systemic cytokine levels through the cholinergic anti-inflammatory pathway. Inflammation. 2014;37(5):1763–70.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Zhu Z, Zhou H, Ni Y, Wu C, Zhang C, Ling X. Can dexmedetomidine reduce atrial fibrillation after cardiac surgery? A systematic review and meta-analysis. Drug Design Dev Therapy. 2018;12:521–31.CrossRefGoogle Scholar
  34. 34.
    Wang G, Niu J, Li Z, Lv H, Cai H. The efficacy and safety of dexmedetomidine in cardiac surgery patients: a systematic review and meta-analysis. PLoS One. 2018;13(9):e0202620.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Ling X, Zhou H, Ni Y, Wu C, Zhang C, Zhu Z. Does dexmedetomidine have an antiarrhythmic effect on cardiac patients? A meta-analysis of randomized controlled trials. PLoS One. 2018;13(3):e0193303.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 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
  37. 37.
    Zhang JJ, Peng K, Zhang J, Meng XW, Ji FH. Dexmedetomidine preconditioning may attenuate myocardial ischemia/reperfusion injury by down-regulating the HMGB1-TLR4-MyD88-NF-small ka, CyrillicB signaling pathway. PLoS One. 2017;12(2):e0172006.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 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
  39. 39.
    Wang SL, Duan L, Xia B, Liu Z, Wang Y, Wang GM. Dexmedetomidine preconditioning plays a neuroprotective role and suppresses TLR4/NF-kappaB pathways model of cerebral ischemia reperfusion. Biomed Pharmacotherapy. 2017;93:1337–42.CrossRefGoogle Scholar
  40. 40.
    Chen Z, Qiu PY, Ma CG. Dexmedetomidine preconditioning protects against retinal ischemia/reperfusion injury and inhibits inflammation response via toll-like receptor 4 (TLR4) pathway. Biomed Pharmacotherapy. 2017;93:1018–24.CrossRefGoogle Scholar
  41. 41.
    Liu G, Song H, Qiu L, He A, Tong F, Wan Q, et al. Dexmedetomidine preconditioning inhibits the long term inflammation induced by renal ischemia/reperfusion injury in rats. Acta Cirurgica Brasileira. 2016;31(1):8–14.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 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
  43. 43.
    Miró Ò, de la Red G, Fontanals J. Cessation of paroxysmal atrial fibrillation during acute intravenous propofol administration. Anesthesiology. 2000;92(3):910.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 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
  45. 45.
    Gillinov AM, Bagiella E, Moskowitz AJ, Raiten JM, Groh MA, Bowdish ME, et al. Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med. 2016;374(20):1911–21.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yang Liu
    • 1
  • Lei Zhang
    • 2
  • Suozhu Wang
    • 1
  • Feiping Lu
    • 1
  • Jie Zhen
    • 1
  • Wei Chen
    • 1
    Email author
  1. 1.Department of Intensive Care Unit, Beijing Shijitan HospitalCapital Medical UniversityBeijingChina
  2. 2.Department of anesthesiologyBeijing Daxing Maternal and Child Care HospitalBeijingChina

Personalised recommendations