Association of Dexmedetomidine With New-Onset Atrial Fibrillation in Patients With Critical Illness

Abstract

ImportanceDexmedetomidine is a widely used sedative in the intensive care unit (ICU) and has unique properties that may be associated with reduced occurrence of new-onset atrial fibrillation (NOAF).ObjectiveTo investigate whether the use of dexmedetomidine is associated with the incidence of NOAF in patients with critical illness.Design, Setting, and ParticipantsThis propensity score–matched cohort study was conducted using the Medical Information Mart for Intensive Care-IV database, which includes records of patients admitted to the ICU at Beth Israel Deaconess Medical Center in Boston dating 2008 through 2019. Included patients were those aged 18 years or older and hospitalized in the ICU. Data were analyzed from March through May 2022.ExposurePatients were divided into 2 groups according to dexmedetomidine exposure: those who received dexmedetomidine within 48 hours after ICU admission (dexmedetomidine group) and those who never received dexmedetomidine (no dexmedetomidine group).Main Outcomes and MeasuresThe primary outcome was the occurrence of NOAF within 7 days of ICU admission, as defined by the nurse-recorded rhythm status. Secondary outcomes were ICU length of stay, hospital length of stay, and in-hospital mortality.ResultsThis study included 22 237 patients before matching (mean [SD] age, 65.9 [16.7] years; 12 350 male patients [55.5%]). After 1:3 propensity score matching, the cohort included 8015 patients (mean [SD] age, 61.0 [17.1] years; 5240 males [65.4%]), among whom 2106 and 5909 patients were in the dexmedetomidine and no dexmedetomidine groups, respectively. Use of dexmedetomidine was associated with a decreased risk of NOAF (371 patients [17.6%] vs 1323 patients [22.4%]; hazard ratio, 0.80; 95% CI, 0.71-0.90). Although patients in the dexmedetomidine group had longer median (IQR) length of stays in the ICU (4.0 [2.7-6.9] days vs 3.5 [2.5-5.9] days; P < .001) and hospital (10.0 [6.6-16.3] days vs 8.8 [5.9-14.0] days; P < .001), dexmedetomidine was associated with decreased risk of in-hospital mortality (132 deaths [6.3%] vs 758 deaths [12.8%]; hazard ratio, 0.43; 95% CI, 0.36-0.52).Conclusions and RelevanceThis study found that dexmedetomidine was associated with decreased risk of NOAF in patients with critical illness, suggesting that it may be necessary and warranted to evaluate this association in future clinical trials.

Dexmedetomidine as an effective alternative tool for heart rate control in atrial fibrillation during general anesthesia—A case report

“…Further research is needed to determine dexmedetomidine’s role in tachyarrhythmia management, and refining dosing and administration strategies. [ 10 11 ]…”

Mapping Theme Trends and Research Frontiers in Dexmedetomidine Over Past Decade: A Bibliometric Analysis

“…In the clinical setting, dexmedetomidine has been extensively used in intensive care unit (ICU) patients for sedation, hemodynamic stabilization, and as a complement to peripheral nerve block (PNB) and an integral component of opioid-free anesthesia (OFA). 5–15 Several pivotal clinical studies have unveiled its potential effects in mitigating postoperative delirium (POD) and ameliorating postoperative cognitive dysfunction (POCD). 10 , 16–19 Nevertheless, to date, several large-scale multicenter randomized controlled trials (RCT) have yielded inconclusive or conflicting findings.…”