title: 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.
  
  
  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.
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.). jacqueline.m.shuplock@vanderbilt.edu.
authors: Jacqueline M
authors: JM
authors: Shuplock
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Andrew H
authors: AH
authors: Smith
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Jill
authors: J
authors: Owen
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Sara L
authors: SL
authors: Van Driest
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Matt
authors: M
authors: Marshall
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Benjamin
authors: B
authors: Saville
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Meng
authors: M
authors: Xu
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Andrew E
authors: AE
authors: Radbill
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Frank A
authors: FA
authors: Fish
authors: From the Thomas P. Graham Jr. Division of Pediatric Cardiology (J.M.S., A.H.S., J.O., A.E.R., F.A.F., P.J.K.), Division of Pediatric Critical Care Medicine (A.H.S.), and Division of General Pediatrics (S.L.V.D.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pharmaceutical Services at Vanderbilt University Medical Center, Nashville, TN (M.M.); and Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN (B.S., M.X.).
authors: Prince J
authors: PJ
authors: Kannankeril
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D001919:Bradycardia / Q000139:chemically induced / Q000453:epidemiology; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013610:Tachycardia / Q000139:chemically induced / Q000453:epidemiology; D013714:Tennessee / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D020927:Dexmedetomidine
keywords: arrhythmias, cardiac; general surgery; heart defects, congenital; pediatric intensive care units