Does dexmedetomidine have an antiarrhythmic effect on cardiac patients? A meta-analysis of randomized controlled trials

Abstract

BackgroundCardiac surgery patients often experience several types of tachyarrhythmias after admission to the intensive care unit (ICU), which increases mortality and morbidity. Dexmedetomidine (DEX) is a popular medicine used for sedation in the ICU, and its other pharmacological characteristics are gradually being uncovered.PurposeTo determine whether DEX has an antiarrhythmic effect after cardiac surgery.MethodsThe three primary databases MEDLINE, Embase (OVID SP) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched, and all English-language and randomized control-designed clinical publications comparing DEX to control medicines for sedation after elective cardiac surgery were included. Two colleagues independently extracted the data and performed other quality assessments. A subgroup analysis was performed according to the different medicines used and whether cardiopulmonary bypass (CPB) was applied. All tachyarrhythmias that occurred in the atria and ventricles were analyzed.ResultsA total of 1295 patients in 9 studies met the selection criteria among 2587 studies that were screened. After quantitative synthesis, our results revealed that the DEX group was associated with a lower incidence of ventricular arrhythmia (VA, OR 0.24, 95% CI 0.09–0.64, I2 = 0%, P = 0.005) than the control group. Subgroup analysis did not reveal a significant difference between the DEX and propofol subgroups (OR 0.13, 95% CI 0.03–0.56, I2 = 0%, P = 0.007). Additionally, no difference in the incidence of atrial fibrillation (AF) was observed regardless of the different control medicines (OR 0.82, 95% CI 0.60–1.10, I2 = 25%, P = 0.19) or whether CPB was applied.ConclusionsThis meta-analysis revealed that DEX has an antiarrhythmic effect that decreases the incidence of VA compared to other drugs used for sedation following cardiac surgery. DEX may not have an effect on AF, but cautious interpretation should be exercised due to high heterogeneity.

Effect of Dexmedetomidine on Atrial Fibrillation-Based Tachyarrhythmia After Cardiac Surgery: A Systematic Review and Meta-Analysis 

“…Previous systematic reviews and meta-analysis [20,42] found that DEX did not affect AF incidence after cardiac surgery. However, Liu et al [43] indicated that DEX could reduce the incidence of AF and VT after cardiac surgery but has no effect on VF incidence (this result was consistent with our research results).…”

The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome

“…An additional advantage of dexmedetomidine over physostigmine is its lower arrhythmogenic potential [18][19][20]. It is safe and may even be protective, in the setting of prolonged QTc [21][22][23].…”

“…In the latest report by National Poison Data Systems, there are more than 40,000 exposures to antihistamines in children with exposures growing by over 1,000 every year over the last ten years. In 2018, antihistamines were found to be the second most common cause of pharmaceutical death in ages [13][14][15][16][17][18][19]. This is in addition to other medications that cause anticholinergic presentations such as antipsychotics and nonpharmaceutical exposures [1].…”

Effects of anesthetic and sedative agents on sympathetic nerve activity

“…32 A meta-analysis including 1295 patients in 9 studies concluded that dexmedetomidine is associated with a lower incidence of ventricular arrhythmia after elective cardiac surgery. 33 Methohexital minimizes the possibility of potentially life-threatening cardiac arrhythmias during electroconvulsive therapy compared with thiamylal or thiopental. 34 In contrast, midazolam, which does not suppress SKNA, does not alter the inducibility of reentrant tachycardia nor has it be shown to affect the sinoatrial node, refractory periods of atrioventricular conduction, or accessory pathways.…”