Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease.
OBJECTIVE
Assessment of electrocardiographic (ECG) effects of dexmedetomidine.


METHODS
Prospective observational study including children 0-17 years of age with congenital heart disease (CHD) and children following cardiothoracic surgery. Patients who did not receive dexmedetomidine were used as a control group. All patients had two ECGs: one baseline, pre-dexmedetomidine (T1) and one during dexmedetomidine infusion (T2).


RESULTS
Fifty-one patients, median age of 0.5 years (IQR = 3.4), and 25 patients, age 0.25 (IQR = 2.9), were included in the dexmedetomidine and control groups, respectively. Forty received a dexmedetomidine-loading dose of 1 microg/kg (IQR = 0.5). At T2, the dexmedetomidine infusion was 1 microg/kg/h (IQR = 0.5). In the dexmedetomidine group, heart rate (HR) decreased from 140 +/- 22 to 115 +/- 23 (P < 0.001); PR, PRc and PR index changed from 115 +/- 28 to 122 +/- 29 ms (P = 0.01), 174 +/- 38 to 167 +/- 35 ms (P = 0.07) and 15,882 +/- 3,565 to 13,792 +/- 3,311 (P < 0.001), respectively. QRS decreased from 84 +/- 21 to 80 +/- 21 ms (P = 0.02), and QTc had no change (433 +/- 47 to 435 +/- 36 ms). When compared to the control group, none of the ECG intervals had any difference other than a trend towards lower HR (P = 0.08). Neonates and infants had a bigger drop in the HR compared to older children (P < 0.001), while other parameters were similar. At T2 none of the dexmedetomidine group patients had atrioventricular block or other arrhythmia. Four patients in the control group had accelerated junctional rhythm.


CONCLUSIONS
Use of dexmedetomidine in patients with CHD and patients following cardiothoracic surgery is not associated with any significant ECG interval abnormalities other than a trend towards lower HR.
Chrysostomou
Constantinos
C
Department of Pediatric Cardiology, Division of Cardiac Intensive Care, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15201, USA. chrycx@chp.edu
Komarlu
Rukmini
R
Lichtenstein
Steven
S
Shiderly
Dana
D
Arora
Gaurav
G
Orr
Richard
R
Wearden
Peter D
PD
Morell
Victor O
VO
Munoz
Ricardo
R
Jooste
Edmund H
EH
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000704:Analysis of Variance; D054537:Atrioventricular Block; D006348:Cardiac Surgical Procedures; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies
D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine