Association between perioperative dexmedetomidine and arrhythmias after surgery for congenital heart disease

Circ Arrhythm Electrophysiol. 2015 Jun;8(3):643-50. doi: 10.1161/CIRCEP.114.002301. Epub 2015 Apr 15.

Abstract

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.

Keywords: arrhythmias, cardiac; general surgery; heart defects, congenital; pediatric intensive care units.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-2 Receptor Agonists / adverse effects*
  • Arrhythmias, Cardiac / chemically induced*
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / epidemiology
  • Arrhythmias, Cardiac / physiopathology
  • Bradycardia / chemically induced
  • Bradycardia / epidemiology
  • Cardiac Surgical Procedures*
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Dexmedetomidine / adverse effects*
  • Female
  • Heart Defects, Congenital / surgery*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Propensity Score
  • Retrospective Studies
  • Risk Factors
  • Tachycardia / chemically induced
  • Tachycardia / epidemiology
  • Tennessee / epidemiology
  • Time Factors
  • Treatment Outcome

Substances

  • Adrenergic alpha-2 Receptor Agonists
  • Dexmedetomidine