Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

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.