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

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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.

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Reference

  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.

    Article  Google Scholar 

  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).

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google 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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google 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 

  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.

    Article  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.

  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.

    Article  CAS  Google 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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google 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.

  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.

    Article  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.

    Article  CAS  Google Scholar 

  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.

  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.

  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.

    Article  Google 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.

    Article  CAS  Google Scholar 

  43. Miró Ò, de la Red G, Fontanals J. Cessation of paroxysmal atrial fibrillation during acute intravenous propofol administration. Anesthesiology. 2000;92(3):910.

    Article  Google 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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China

    Yang Liu, Suozhu Wang, Feiping Lu, Jie Zhen & Wei Chen

  2. Department of anesthesiology, Beijing Daxing Maternal and Child Care Hospital, Beijing, China

    Lei Zhang

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  1. Yang Liu
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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.

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Correspondence to Wei Chen.

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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.

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Liu, Y., Zhang, L., Wang, S. et al. Dexmedetomidine Reduces Atrial Fibrillation After Adult Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiovasc Drugs 20, 271–281 (2020). https://doi.org/10.1007/s40256-019-00380-2

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