Effect of preoperative application of dexmedetomidine on atrial fibrillation after coronary artery bypass grafting: A propensity score-matching analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Zhipeng ^1,2 , ZHANG Jian ² , LI Rui ^1,2 , LIANG Hanqing ² , LIU Zhuxian ³ , XIN Fangran ² , YIN Zongtao ² ,  HAN Jinsong ²

1. Graduate School, General Hospital of Northern Theater Command, China Medical University, Shenyang, 110016, P. R. China;
2. Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
3. Shenyang Pharmaceutical University, Shenyang, 110016, P. R. China;

Corresponding author：

HAN Jinsong, Email: hanjs0216@sina.com

Keywords：

Coronary artery bypass grafting; atrial fibrillation; dexmedetomidine; diazepam; propensity score-matching analysis

DOI：

10.7507/1007-4848.202206049

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Objective To evaluate the incidence of postoperative atrial fibrillation (POAF) after dexmedetomidine and diazepam in patients undergoing coronary artery bypass grafting (CABG). Methods A retrospective cohort study was conducted in the patients who underwent CABG in the General Hospital of Northern Theater Command from October 2020 to June 2021. By propensity score-matching method, the incidence of POAF after dexmedetomidine and diazepam application in patients undergoing CABG was evaluated. Results Finally 207 patients were collected, including 150 males and 57 females, with an average age of 62.02±8.38 years. Among the 207 patients, 53 were treated with dexmedetomidine and 154 with diazepam before operation. There was a statistical difference in the proportion of hypertension patients and smoking patients between the two groups before matching (P<0.05). According to the 1∶1 propensity score-matching method, there were 53 patients in each of the two groups, with no statistical difference between the two groups after matching. After matching, the incidence of POAF in the dexmedetomidine group was lower than that in the diazepam group [9.43% (5/53) vs. 30.19% (16/53), P=0.007]. There was no death in the two groups during hospitalization, and there was no statistical difference in the main adverse events after operation. The ICU stay (21.28±2.69 h vs. 22.80±2.56 h, P=0.004) and mechanical ventilation time (18.53±2.25 h vs. 19.85±2.01 h, P=0.002) in the dexmedetomidine group were shorter. Regression analysis showed that age, smoking and diabetes were related to the increased incidence of POAF (P<0.05), and preoperative use of dexmedetomidine was associated with a reduced incidence of POAF (P=0.002). Conclusion For patients undergoing CABG, the incidence of POAF with dexmedetomidine before operation is lower than that with diazepam. Preoperative application of dexmedetomidine is the protective factor for POAF, and old age, smoking and diabetes are the risk factors for POAF.

Citation： GUO Zhipeng, ZHANG Jian, LI Rui, LIANG Hanqing, LIU Zhuxian, XIN Fangran, YIN Zongtao, HAN Jinsong. Effect of preoperative application of dexmedetomidine on atrial fibrillation after coronary artery bypass grafting: A propensity score-matching analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 428-433. doi: 10.7507/1007-4848.202206049 Copy

1.	Almassi GH, Hawkins RB, Bishawi M, et al. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. J Thorac Cardiovasc Surg, 2021, 161(5): 1803-1810.
2.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2011, 58(24): e123-e210.
3.	Greenberg JW, Lancaster TS, Schuessler RB, et al. Postoperative atrial fibrillation following cardiac surgery: A persistent complication. Eur J Cardiothorac Surg, 2017, 52(4): 665-672.
4.	Megens MR, Churilov L, Thijs V. New-onset atrial fibrillation after coronary artery bypass graft and long-term risk of stroke: A meta-analysis. J Am Heart Assoc, 2017, 6(12): e007558.
5.	Kerwin M, Saado J, Pan J, et al. New-onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery: A systematic review and meta-analysis. Clin Cardiol, 2020, 43(9): 928-934.
6.	Ngaage DL, Schaff HV, Mullany CJ, et al. Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting? J Thorac Cardiovasc Surg, 2007, 133(1): 182-189.
7.	Pivatto Júnior F, Teixeira Filho GF, Sant'anna JR, et al. Advanced age and incidence of atrial fibrillation in the postoperative period of aortic valve replacement. Rev Bras Cir Cardiovasc, 2014, 29(1): 45-50.
8.	Soltani G, Jahanbakhsh S, Tashnizi MA, et al. Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial. Electron Physician, 2017, 9(10): 5578-5587.
9.	Turan A, Bashour CA, You J, et al. Dexmedetomidine sedation after cardiac surgery decreases atrial arrhythmias. J Clin Anesth, 2014, 26(8): 634-642.
10.	Narisawa A, Nakane M, Kano T, et al. Dexmedetomidine sedation during the nighttime reduced the incidence of postoperative atrial fibrillation in cardiovascular surgery patients after tracheal extubation. J Intensive Care, 2015, 3(1): 26.
11.	Bulow NM, Colpo E, Pereira RP, et al. Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass. Braz J Med Biol Res, 2016, 49(4): e4646.
12.	Ren J, Zhang H, Huang L, et al. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery. Exp Ther Med, 2013, 6(2): 497-502.
13.	Liu Y, Zhang L, Wang S, et al. Dexmedetomidine reduces atrial fibrillation after adult cardiac surgery: A meta-analysis of randomized controlled trials. Am J Cardiovasc Drugs, 2020, 20(3): 271-281.
14.	Krishna VR, Patil N, Nileshwar A. Prospective evaluation of the utility of CHA2DS2-VASc score in the prediction of postoperative atrial fibrillation after off-pump coronary artery bypass surgery: An observational study. Ann Card Anaesth, 2020, 23(2): 122-126.
15.	Dogan A, Gunesdogdu F, Sever K, et al. Atrial fibrillation prediction by surgical risk scores following isolated coronary artery bypass grafting surgery. J Coll Physicians Surg Pak, 2019, 29(11): 1038-1042.
16.	Kievišas M, Keturakis V, Vaitiekūnas E, et al. Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg, 2017, 65(10): 566-574.
17.	Pollock BD, Filardo G, da Graca B, et al. Predicting new-onset post-coronary artery bypass graft atrial fibrillation with existing risk scores. Ann Thorac Surg, 2018, 105(1): 115-121.
18.	Lin YY, He B, Chen J, et al. Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? A meta-analysis. Crit Care, 2012, 16(5): R169.
19.	Massoumi G, Mansouri M, Khamesipour S. Comparison of the incidence and severity of delirium and biochemical factors after coronary artery bypass grafting with dexmedetomidine: A randomized double-blind placebo-controlled clinical trial study. ARYA Atheroscler, 2019, 15(1): 14-21.
20.	Kramer PA, Chacko BK, Ravi S, et al. Hemoglobin-associated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients. Lab Invest, 2015, 95(2): 132-141.
21.	Kramer PA, Chacko BK, George DJ, et al. Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients. Biosci Rep, 2015, 35(4): e00237.
22.	Wu SJ, Lin ZH, Lin YZ, et al. Dexmedetomidine exerted anti-arrhythmic effects in rat with ischemic cardiomyopathy via upregulation of connexin 43 and reduction of fibrosis and inflammation. Front Physiol, 2020, 11: 33.
23.	Zhai W, Yang L, Sun P, et al. Effect of dexmedetomidine on hemodynamic changes and inflammatory responses in patients undergoing off-pump coronary-artery bypass grafting. Exp Ther Med, 2020, 20(6): 250.
24.	Anderson EJ, Efird JT, Kiser AC, et al. Plasma catecholamine levels on the morning of surgery predict post-operative atrial fibrillation. JACC Clin Electrophysiol, 2017, 3(12): 1456-1465.
25.	Uusalo P, Al-Ramahi D, Tilli I, et al. Subcutaneously administered dexmedetomidine is efficiently absorbed and is associated with attenuated cardiovascular effects in healthy volunteers. Eur J Clin Pharmacol, 2018, 74(8): 1047-1054.
26.	Tobias JD, Chrysostomou C. Dexmedetomidine: Antiarrhythmic effects in the pediatric cardiac patient. Pediatr Cardiol, 2013, 34(4): 779-785.
27.	Riquelme JA, Westermeier F, Hall AR, et al. Dexmedetomidine protects the heart against ischemia-reperfusion injury by an endothelial eNOS/NO dependent mechanism. Pharmacol Res, 2016, 103: 318-327.
28.	Zhang J, Jiang H, Liu DH, et al. Effects of dexmedetomidine on myocardial ischemia-reperfusion injury through PI3K-Akt-mTOR signaling pathway. Eur Rev Med Pharmacol Sci, 2019, 23(15): 6736-6743.

1. Almassi GH, Hawkins RB, Bishawi M, et al. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. J Thorac Cardiovasc Surg, 2021, 161(5): 1803-1810.
2. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2011, 58(24): e123-e210.
3. Greenberg JW, Lancaster TS, Schuessler RB, et al. Postoperative atrial fibrillation following cardiac surgery: A persistent complication. Eur J Cardiothorac Surg, 2017, 52(4): 665-672.
4. Megens MR, Churilov L, Thijs V. New-onset atrial fibrillation after coronary artery bypass graft and long-term risk of stroke: A meta-analysis. J Am Heart Assoc, 2017, 6(12): e007558.
5. Kerwin M, Saado J, Pan J, et al. New-onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery: A systematic review and meta-analysis. Clin Cardiol, 2020, 43(9): 928-934.
6. Ngaage DL, Schaff HV, Mullany CJ, et al. Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting? J Thorac Cardiovasc Surg, 2007, 133(1): 182-189.
7. Pivatto Júnior F, Teixeira Filho GF, Sant'anna JR, et al. Advanced age and incidence of atrial fibrillation in the postoperative period of aortic valve replacement. Rev Bras Cir Cardiovasc, 2014, 29(1): 45-50.
8. Soltani G, Jahanbakhsh S, Tashnizi MA, et al. Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial. Electron Physician, 2017, 9(10): 5578-5587.
9. Turan A, Bashour CA, You J, et al. Dexmedetomidine sedation after cardiac surgery decreases atrial arrhythmias. J Clin Anesth, 2014, 26(8): 634-642.
10. Narisawa A, Nakane M, Kano T, et al. Dexmedetomidine sedation during the nighttime reduced the incidence of postoperative atrial fibrillation in cardiovascular surgery patients after tracheal extubation. J Intensive Care, 2015, 3(1): 26.
11. Bulow NM, Colpo E, Pereira RP, et al. Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass. Braz J Med Biol Res, 2016, 49(4): e4646.
12. Ren J, Zhang H, Huang L, et al. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery. Exp Ther Med, 2013, 6(2): 497-502.
13. Liu Y, Zhang L, Wang S, et al. Dexmedetomidine reduces atrial fibrillation after adult cardiac surgery: A meta-analysis of randomized controlled trials. Am J Cardiovasc Drugs, 2020, 20(3): 271-281.
14. Krishna VR, Patil N, Nileshwar A. Prospective evaluation of the utility of CHA2DS2-VASc score in the prediction of postoperative atrial fibrillation after off-pump coronary artery bypass surgery: An observational study. Ann Card Anaesth, 2020, 23(2): 122-126.
15. Dogan A, Gunesdogdu F, Sever K, et al. Atrial fibrillation prediction by surgical risk scores following isolated coronary artery bypass grafting surgery. J Coll Physicians Surg Pak, 2019, 29(11): 1038-1042.
16. Kievišas M, Keturakis V, Vaitiekūnas E, et al. Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg, 2017, 65(10): 566-574.
17. Pollock BD, Filardo G, da Graca B, et al. Predicting new-onset post-coronary artery bypass graft atrial fibrillation with existing risk scores. Ann Thorac Surg, 2018, 105(1): 115-121.
18. Lin YY, He B, Chen J, et al. Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? A meta-analysis. Crit Care, 2012, 16(5): R169.
19. Massoumi G, Mansouri M, Khamesipour S. Comparison of the incidence and severity of delirium and biochemical factors after coronary artery bypass grafting with dexmedetomidine: A randomized double-blind placebo-controlled clinical trial study. ARYA Atheroscler, 2019, 15(1): 14-21.
20. Kramer PA, Chacko BK, Ravi S, et al. Hemoglobin-associated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients. Lab Invest, 2015, 95(2): 132-141.
21. Kramer PA, Chacko BK, George DJ, et al. Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients. Biosci Rep, 2015, 35(4): e00237.
22. Wu SJ, Lin ZH, Lin YZ, et al. Dexmedetomidine exerted anti-arrhythmic effects in rat with ischemic cardiomyopathy via upregulation of connexin 43 and reduction of fibrosis and inflammation. Front Physiol, 2020, 11: 33.
23. Zhai W, Yang L, Sun P, et al. Effect of dexmedetomidine on hemodynamic changes and inflammatory responses in patients undergoing off-pump coronary-artery bypass grafting. Exp Ther Med, 2020, 20(6): 250.
24. Anderson EJ, Efird JT, Kiser AC, et al. Plasma catecholamine levels on the morning of surgery predict post-operative atrial fibrillation. JACC Clin Electrophysiol, 2017, 3(12): 1456-1465.
25. Uusalo P, Al-Ramahi D, Tilli I, et al. Subcutaneously administered dexmedetomidine is efficiently absorbed and is associated with attenuated cardiovascular effects in healthy volunteers. Eur J Clin Pharmacol, 2018, 74(8): 1047-1054.
26. Tobias JD, Chrysostomou C. Dexmedetomidine: Antiarrhythmic effects in the pediatric cardiac patient. Pediatr Cardiol, 2013, 34(4): 779-785.
27. Riquelme JA, Westermeier F, Hall AR, et al. Dexmedetomidine protects the heart against ischemia-reperfusion injury by an endothelial eNOS/NO dependent mechanism. Pharmacol Res, 2016, 103: 318-327.
28. Zhang J, Jiang H, Liu DH, et al. Effects of dexmedetomidine on myocardial ischemia-reperfusion injury through PI3K-Akt-mTOR signaling pathway. Eur Rev Med Pharmacol Sci, 2019, 23(15): 6736-6743.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of preoperative application of dexmedetomidine on atrial fibrillation after coronary artery bypass grafting: A propensity score-matching analysis

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