Seoul, Republic of Korea—Dexmedetomidine is widely used as a sedative in ICUs. Now, a new study suggests that the medication has unique properties that might be associated with reduced occurrence of new-onset atrial fibrillation (NOAF).

Korean researchers conducted a propensity score–matched cohort study to investigate whether the use of dexmedetomidine is associated with the incidence of NOAF in patients with a critical illness.

Data were from the Medical Information Mart for Intensive Care-IV database, which includes records of patients admitted to the ICU at Beth Israel Deaconess Medical Center in Boston from 2008 through 2019. Participants were adults who were hospitalized in the ICU, with data analyzed from March through May 2022.

The results were published in Journal of the American Medical Association Network Open.

The patients were divided into two groups according to dexmedetomidine exposure: those who received dexmedetomidine within 48 hours after ICU admission (dexmedetomidine group) and those who never received dexmedetomidine (no dexmedetomidine group). After 1:3 propensity score matching, the cohort included 8,015 patients with a mean age of 61; 65.4% were male.

The primary outcome was defined as the occurrence of NOAF within 7 days of ICU admission, as defined by the nurse-recorded rhythm status. Secondary outcomes considered were ICU length of stay (LOS), hospital LOS, and in-hospital mortality.

The results indicated that the use of dexmedetomidine was associated with a decreased risk of NOAF (371 patients [17.6%] vs. 1,323 patients [22.4%]; hazard ratio, 0.80; 95% CI, 0.71-0.90).

“Although patients in the dexmedetomidine group had longer median (IQR [interquartile range]) length of stays in the ICU (4.0 [2.7-6.9] days vs. 3.5 [2.5-5.9] days; P <.001) and hospital (10.0 [6.6-16.3] days vs. 8.8 [5.9-14.0] days; P <.001), dexmedetomidine was associated with decreased risk of in-hospital mortality (132 deaths [6.3%] vs. 758 deaths [12.8%]; hazard ratio, 0.43; 95% CI, 0.36-0.52),” the study advised.

The authors concluded that because their findings suggested that dexmedetomidine was associated with decreased risk of NOAF in patients with critical illness, “it may be necessary and warranted to evaluate this association in future clinical trials.”

Atrial fibrillation is the most common type of arrhythmia in patients with critical illness. NOAF ranges in incidence from 10% to 44% in patients with sepsis, for example.

The authors noted that commonly proposed risk factors associated with NOAF in patients admitted to the ICU include mechanical ventilation, vasoactive drugs, systemic inflammation, and organ dysfunction. The condition might cause adverse hemodynamic outcomes, systemic embolism, or stroke, resulting in worse clinical outcomes with longer ICU LOS and higher mortality compared with patients without NOAF.

Dexmedetomidine, a highly selective alpha 2-receptor agonist widely used for sedation in patients with critical illness, has sympatholytic activity that is associated with reduced heart rate and depressed sinus node and atrial ventricular node conduction. In addition, studies have suggested that dexmedetomidine was associated with cytokine transcription and inhibited inflammation. “These properties collectively suggest that dexmedetomidine may be promising as a treatment associated with decreased risk of NOAF,” the researchers wrote.

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