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SYSTEMATIC REVIEW article

Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1433841

Dexmedetomidine vs. propofol on arrhythmia in cardiac surgery: A meta-analysis of randomized controlled trials

Provisionally accepted
Juan Peng Juan Peng 1Yifan Wu Yifan Wu 2Lin Li Lin Li 3Panpan Xia Panpan Xia 2Zhang Jing Zhang Jing 2Xiao Liu Xiao Liu 4*
  • 1 Third Hospital of Nanchang, Nanchang, Jiangxi Province, China
  • 2 Second Hospital of Nanchang, Nanchang, Jiangxi Province, China
  • 3 Fujian Medical University, Fuzhou, Fujian Province, China
  • 4 Sun Yat-sen University, Guangzhou, China

The final, formatted version of the article will be published soon.

    Background: Dexmedetomidine (DEX) and propofol are popular anesthetics, but it remains unknown whether DEX reduces the incidence of arrhythmias compared with propofol after cardiac surgery. Methods: We performed a comprehensive search for RCTs (Randomized Controlled Trials) that compared the incidence of arrhythmias between DEX and propofol in adults who had undergone cardiac surgery across three databases (PubMed, Embase, the Cochrane Library), and ClinicalTrials.gov up to October 3, 2023. The primary outcome was ventricular arrhythmias, the secondary outcomes were bradycardia and atrial fibrillation (AF). Results: Our analysis included 7 RCTs with 1,004 patients (mean age: 64.37, male: 71.11%) undergoing cardiac surgery, and the incidence of in-hospital arrhythmia was 22.01% (ventricular arrhythmias 2.75%, bradycardia 3.33%, AF 18.63%). Perioperative or postoperative use of DEX reduced the incidence of in-hospital ventricular arrhythmias (Odds Ratio [OR] 0.14, 95% Confidence Interval [CI] 0.03-0.66), but increased the risk of in-hospital bradycardia (OR 2.88, 95% CI 1.02-8.17) compared with propofol. The trial sequence analysis verified the adequacy of sample size and robustness of the ventricular arrhythmias and bradycardia. There was no significant reduced incidence of the use of DEX in the incidence of AF (OR 0.69, 95% CI 0.36-1.29). The GRADE assessment indicated a high certainty for ventricular arrhythmias and bradycardia and a moderate certainty for AF. Conclusions: Our findings suggested the use of DEX reduces in-hospital ventricular arrhythmias but increases bradycardia incidence compared to propofol in adult patients undergoing cardiac surgery. Further studies are needed to assess the impact of dexmedetomidine on atrial fibrillation compared to propofol.

    Keywords: cardiac surgery, Dexmedetomidine, Meta-analysis, Propofol, Ventricular arrhythmias

    Received: 24 May 2024; Accepted: 27 Sep 2024.

    Copyright: © 2024 Peng, Wu, Li, Xia, Jing and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xiao Liu, Sun Yat-sen University, Guangzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.