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Impact of dexmedetomidine on electrophysiological properties and arrhythmia inducibility in adult patients referred for reentrant supraventricular tachycardia ablation

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Abstract

Background

Drugs used for sedation/analgesia may affect the basic cardiac electrophysiologic properties or even supraventricular tachycardia (SVT) inducibility. Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist with sedative and analgesic properties. A comprehensive evaluation on use of DEX for reentrant SVT ablation in adults is lacking. The present study aims to systematically assess the impact of DEX on cardiac electrophysiology and SVT inducibility.

Methods

Hemodynamic, electrocardiographic, and electrophysiological parameters and SVT inducibility were assessed before and after DEX infusion in patients scheduled for ablation of reentrant SVT.

Results

The population of this prospective observational study included 55 patients (mean age of 58.7 ± 14 years, 29 males [52.7%]). A decrease in systolic and diastolic blood pressure and in heart rate was observed after DEX infusion (p = 0.001 for all). DEX increased corrected sinus node refractory time, atrial effective refractory period, AH interval, AV Wenckebach cycle length, and AV node effective refractory period without affecting the His-Purkinje conduction or ventricular myocardium refractoriness. No AV blocks or sinus arrests occurred during DEX infusion. Globally, there was no difference in SVT inducibility in basal condition or after DEX infusion (46/55 [83.6%] vs. 43/55 [78.1%] patients; p = 0.55), without a difference in isoprenaline use (p = 1.0). In 4 (7.3%) cases, the SVT was inducible only after DEX infusion. In 34.5% of cases, DEX infusion unmasked the presence of an obstructive sleeping respiratory pattern, represented mainly by snoring.

Conclusions

DEX depresses sinus node function and prolongs atrioventricular refractoriness without significantly affecting the rate of SVT inducibility in patients scheduled for reentrant SVT ablation

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Abbreviations

AES:

atrial extrastimulus

AV:

atrioventricular

AVNRT:

atrioventricular nodal reentrant tachycardia

AVRT:

atrioventricular reentrant tachycardia

AERP:

atrial effective refractory period

AVNERP:

atrioventricular effective refractory period

BMI:

body mass index

cSNRT:

corrected sinus nodal recovery time

CS:

coronary sinus

DEX:

dexmedetomidine

DBP:

diastolic blood pressure

ECG:

electrocardiogram

EP:

electrophysiological

EPS:

electrophysiological study

HR:

heart rate

OSAS:

obstructive sleep apnea syndrome

SBP:

systolic blood pressure

VERP:

ventricular effective refractory period

RF:

radiofrequency

SVT:

supraventricular tachycardia

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Authors and Affiliations

  1. Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, Florence, Italy

    Andrea Bernardini, Alessandro Paoletti Perini, Margherita Padeletti, Umberto Signorini, Massimo Milli & Andrea Giomi

  2. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Andrea Bernardini & Davide Ciliberti

  3. Anesthesiology Unit, Santa Maria Nuova Hospital, Florence, Italy

    Claudio Poli

Authors
  1. Andrea Bernardini
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  2. Alessandro Paoletti Perini
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  4. Umberto Signorini
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Correspondence to Andrea Bernardini.

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This study complies with the Declaration of Helsinki and all participants provided written informed consent.

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Bernardini, A., Paoletti Perini, A., Padeletti, M. et al. Impact of dexmedetomidine on electrophysiological properties and arrhythmia inducibility in adult patients referred for reentrant supraventricular tachycardia ablation. J Interv Card Electrophysiol 67, 371–378 (2024). https://doi.org/10.1007/s10840-023-01640-7

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  • DOI: https://doi.org/10.1007/s10840-023-01640-7

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