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

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.

背景：心脏外科患者入住重症监护病房（intensive care unit, ICU）后常发生多种快速性心律失常，可增加其死亡率与致残率。右美托咪定（Dexmedetomidine, DEX）是ICU中广泛应用的镇静药物，其其他药理学特性正逐步被揭示。
目的：本研究旨在明确心脏外科术后右美托咪定是否具有抗心律失常作用。
方法：本研究检索了MEDLINE、Embase（OVID SP）及Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials, CENTRAL）三大主流数据库，纳入所有以英语发表、针对择期心脏外科术后镇静治疗比较右美托咪定与对照药物的随机对照临床研究。两名研究人员独立完成数据提取与质量评价，并根据所用镇静药物种类及是否采用体外循环（cardiopulmonary bypass, CPB）开展亚组分析，同时对心房与心室发生的所有快速性心律失常进行汇总分析。
结果：本研究共筛选2587篇文献，最终纳入9项符合标准的研究，涉及1295例患者。经定量合成分析显示，相较于对照组，右美托咪定组心室性心律失常（ventricular arrhythmia, VA）发生率更低（比值比OR=0.24，95%置信区间CI：0.09~0.64，I²=0%，P=0.005）。亚组分析表明，右美托咪定与丙泊酚亚组间未呈现显著差异（OR=0.13，95%CI：0.03~0.56，I²=0%，P=0.007）。此外，无论对照药物种类如何，或是是否采用体外循环，均未观察到心房颤动（atrial fibrillation, AF）发生率存在显著差异（OR=0.82，95%CI：0.60~1.10，I²=25%，P=0.19）。
结论：本荟萃分析结果显示，相较于心脏外科术后镇静所用的其他药物，右美托咪定具有抗心律失常作用，可降低心室性心律失常的发生率。右美托咪定对心房颤动无明显影响，但由于存在较高异质性，对该结果的解读应保持谨慎。