Immediate postoperative dexmedetomidine exposure was not associated with a difference in tachyarrhythmias (29% vs 31%; P=0.66) but increased the odds of bradyarrhythmias requiring intervention.
Cohort (n=1,593)
Does dexmedetomidine administered in the immediate postoperative period reduce the incidence of arrhythmias after surgery for congenital heart disease?
Perioperative dexmedetomidine does not significantly reduce tachyarrhythmias after congenital heart surgery but may increase the risk of bradyarrhythmias requiring intervention.
Absolute Event Rate: 29% vs 31%
p-value: p=0.66
BACKGROUND: Dexmedetomidine is commonly used after congenital heart surgery and may be associated with a decreased incidence of postoperative tachyarrhythmias. Using a large cohort of patients undergoing congenital heart surgery, we examined for an association between dexmedetomidine use in the immediate postoperative period and subsequent arrhythmia development. METHODS AND RESULTS: A total of 1593 surgical procedures for congenital heart disease were performed. Dexmedetomidine was administered in the immediate postoperative period after 468 (29%) surgical procedures. When compared with 1125 controls, the group receiving dexmedetomidine demonstrated significantly fewer tachyarrhythmias (29% versus 38%; P<0.001), tachyarrhythmias receiving intervention (14% versus 23%; P<0.001), bradyarrhythmias (18% versus 22%; P=0.03), and bradyarrhythmias receiving intervention (12% versus 16%; P=0.04). After propensity score matching with 468 controls, the arrhythmia incidence between groups became similar: tachyarrhythmias (29% versus 31%; P=0.66), tachyarrhythmias receiving intervention (14% versus 17%; P=0.16), bradyarrhythmias (18% versus 15%; P=0.44), and bradyarrhythmias receiving intervention (12% versus 9%; P=0.17). After excluding controls exposed to dexmedetomidine at a later time in the hospitalization, dexmedetomidine was associated with increased odds of bradyarrhythmias receiving intervention (odds ratio, 2.18; 95% confidence interval, 1.02-4.65). Furthermore, there was a dose-dependent increase in the odds of bradyarrhythmias (odds ratio, 1.04; 95% confidence interval, 1.01-1.07) and bradyarrhythmias receiving intervention (odds ratio, 1.05; 95% confidence interval, 1.01-1.08). CONCLUSIONS: Although dexmedetomidine exposure in the immediate postoperative period is not associated with a clinically meaningful difference in the incidence of tachyarrhythmias after congenital heart surgery, it may be associated with increased odds of bradyarrhythmias.
Shuplock et al. (Thu,) conducted a cohort in Congenital Heart Disease (n=1,593). Dexmedetomidine vs. No immediate postoperative dexmedetomidine was evaluated on Tachyarrhythmias (propensity score matched) (p=0.66). Immediate postoperative dexmedetomidine exposure was not associated with a difference in tachyarrhythmias (29% vs 31%; P=0.66) but increased the odds of bradyarrhythmias requiring intervention.