Abstract
Background: The incidence of tachyarrhythmia with atrial fibrillation as the main manifestation increases after adult cardiac surgery, which leads to an increase in adverse events. Dexmedetomidine has been widely used in the perioperative period, but the effect of dexmedetomidine on tachyarrhythmia after cardiac surgery in adults remains controversial.Objective: To evaluate the effect of perioperative use of dexmedetomidine on tachyarrhythmia with atrial fibrillation as the main manifestation after cardiac surgery.Methods: We searched six databases, including Embase, PubMed, Cochrane, CNKI, Wanfang, and Sinomed, for literature published up to November 2020, without restrictions on language. The primary endpoint was the number of patients with atrial fibrillation after cardiac surgery. The secondary endpoints included: the number of patients with supraventricular tachycardia, the number of patients with ventricular tachycardia, the number of patients with ventricular fibrillation, the number of patients with myocardial infarction, the number of dead patients, mechanical ventilation duration, and the length of ICU stay and hospitalization. We used Stata (Version 12.0) and Review Manager (Version 5.3) provided by Cochrane Collaboration for data analysis. If the included studies have high statistical heterogeneity (P≤0.1, I2>50%), we will use a random-effects model. Otherwise, a fixed-effects model will be used for calculation.Results: Among the 1388 studies retrieved, a total of 18 studies met our inclusion criteria (N=3171 participants). The use of dexmedetomidine reduced the incidence of atrial fibrillation by 17% (RR=0.83, 95% CI 0.73-0.93; Z=3.06, P=0.002), reduced the incidence of supraventricular tachycardia by about 70% (RR=0.29, 95% CI 0.11-0.77; Z=2.47, P=0.01), reduced the incidence of ventricular tachycardia by about 80% (RR=0.23, 95% CI 0.08-0.63; Z=2.85, P=0.004), but had no effect on the incidence of ventricular fibrillation (RR=1.02, 95% CI 0.14-7.31; Z=0.02, P=0.99）.There was no significant difference in the incidence of myocardial infarction between the two groups (RR = 0.90, 95% CI 0.37-2.18; Z = 0.24, P = 0.81). There was no significant difference in mortality between the two groups (RR = 0.86, 95% CI 0.31-2.44; Z = 0.28, P = 0.78). Dexmedetomidine group can reduce the time of patients in ICU (SMD = - 0.35, 95% CI -0.69 to -0.02; Z = 2.07, P = 0.04), but the heterogeneity between studies is high (I2 = 93%). There was no effect on duration of mechanical ventilation (SMD = -0.10, 95% CI -0.25 to 0.06; Z = 1.18, P = 0.24) and length of hospitalization (SMD = -0.46, 95% CI -1.08 to 0.16; Z = 1.46, P = 0.14).Conclusion: Dexmedetomidine can reduce the incidence of atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia after cardiac surgery in adults but does not affect the occurrence of ventricular fibrillation.Trial registration: CRD42021233613; Registration: Jan 2021
Unusual presentation of supraventricular tachycardia degenerating into ventricular fibrillation during pregnancy: Aortocaval compression the probable culprit
