Can dexmedetomidine reduce atrial fibrillation after cardiac surgery? A systematic review and meta-analysis

Abstract

Purpose: Cardiac surgery patients always present with atrial fibrillation (AF) after admission to the intensive care unit, leading to high mortality and lengthy hospitalization. Dexmedetomidine (DEX) is a popular medication used for sedation in the intensive care unit; however, whether it can reduce AF needs to be analyzed.

Materials and methods: Three primary databases, Medline, Embase (Ovid SP) and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched. All English language and randomized control designed clinical publications comparing DEX to control medicines for sedation after elective cardiac surgery were included. Two independent colleagues conducted the data extraction and quality assessments. The subgroup analysis was performed according to the medicine used, age, AF history, and whether previous beta-blocker premedication and cardiopulmonary bypass (CPB) were applied. The overall incidence of AF was analyzed.

Results: A total of 1,295 patients in nine studies met the selection criteria among 2,587 studies screened from the database. After quantitative synthesis, our results revealed that the DEX group was not associated with a decreased incidence of AF compared with the placebo (risk ratio [RR] 0.76, 95% CI 0.37, 1.55, P=0.44) and morphine groups (RR 0.86, 95% CI 0.56, 1.31, P=0.48). Subgroup analysis also indicated that the DEX vs propofol comparison exhibited no difference: 1) for patients of age >60 years (P=0.69) or ≤60 years (P=0.69); 2) under CPB surgery (P=0.45) or without CPB surgery (P=0.88); 3) with beta-blocker premedication (P=0.32) or without beta-blocker premedication (P=0.90); and 4) with AF history (RR 1.07, 95% CI 0.85, 1.36, P=0.57) or without AF history (P=0.30).

Conclusion: This meta-analysis revealed that DEX could not reduce the incidence of AF compared to control medicines following cardiac surgery. DEX may have an increased influence on AF occurrence if patients had a history of AF. However, cautious interpretation should be made due to high clinical heterogeneity.

Keywords: atrial fibrillation; cardiac surgery; dexmedetomidine; sedation.

Figure 1

Study flow diagram.

Figure 2

Risk of bias presented as percentages for all included studies.

Figure 3

Risk of bias: author’s judgment for all included studies.

Figure 4

Funnel plot of included studies for the incidence of AF. Abbreviation: AF, atrial fibrillation.

Figure 5

Forest plot: the incidence of AF between DEX and placebo groups. Abbreviations: AF, atrial fibrillation; DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 6

Forest plot: the incidence of AF between DEX and morphine groups. Abbreviations: AF, atrial fibrillation; DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 7

Forest plot: the subgroup analysis for age >60 years. Abbreviations: DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 8

Forest plot: the subgroup analysis for age ≤60 years. Abbreviations: DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 9

Forest plot: the subgroup analysis for CPB surgery. Abbreviations: CPB, cardiopulmonary bypass; DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 10

Forest plot: the subgroup analysis without CPB surgery. Abbreviations: CPB, cardiopulmonary bypass; DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 11

Forest plot: the subgroup analysis for beta-blocker premedication. Abbreviations: DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 12

Forest plot: the subgroup analysis without beta-blocker premedication. Abbreviations: DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 13

Forest plot: the subgroup analysis with AF history. Abbreviations: AF, atrial fibrillation; DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 14

Forest plot: the subgroup analysis without AF history. Abbreviations: AF, atrial fibrillation; DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 15

Forest plot: the sensitivity analysis for beta-blocker premedication. Abbreviations: DEX, dexmedetomidine; M–H, Mantel-Haenszel.

Figure 16

Forest plot: the sensitivity analysis for CPB surgery. Abbreviations: CPB, cardiopulmonary bypass; DEX, dexmedetomidine; M–H, Mantel-Haenszel.