Circulation: Arrhythmia and Electrophysiology HAE The Association between Peri-Operative Dexmedetomidine and Arrhythmias after Surgery for Congenital Heart Disease Dexmedetomidine & Arrhythmias with Cardiac Surgery CIRCAE/2014/002301-T CIRCAE/2014/002301-T 10.1161/CIRCEP.114.002301 8 06/16/15 3 Sine Kristina 617-542-5100 617-542-6539 Berul, Charles Children's National Medical Center Dr. Jacqueline Shuplock jacqueline.m.shuplock@vanderbilt.edu Dr. Vanderbilt University 2220 Children's Way Suite 5230 Nashville Tennessee 37232 UNITED STATES 4089308658 6153222210 217571 Jacqueline Shuplock Vanderbilt University jacqueline.m.shuplock@vanderbilt.edu 217571 Andrew Harold Smith Vanderbilt University School of Medicine andrew.h.smith.1@vanderbilt.edu 142512 Jill P Owen Vanderbilt University School of Medicine jillowen4487@aol.com 236573 Sara Van Driest Vanderbilt University sara.van.driest@vanderbilt.edu 139649 Matt Marshall Vanderbilt University matt.marshall@vanderbilt.edu 236427 Benjamin Saville Vanderbilt University Medical Center b.saville@vanderbilt.edu 117714 Meng Xu Vanderbilt University Medical Center meng.xu@vanderbilt.edu 217578 Andrew E Radbill Vanderbilt University andrew.radbill@vanderbilt.edu 62415 Frank A Fish Vanderbilt Children's Hospital frank.fish@vanderbilt.edu 62217 Prince J. Kannankeril Vanderbilt University Medical School prince.kannankeril@Vanderbilt.Edu 38385 05/28/2014 05/28/2014 04/06/2015 04/09/2015 04/17/2015 06/16/2015 Original Articles <P><B><I>Background</I></B>—Dexmedetomidine is commonly used after congenital heart surgery and may be associated with a decreased incidence of post-operative tachyarrhythmias. Using a large cohort of patients undergoing congenital heart surgery, we examined for an association between dexmedetomidine use in the immediate post-operative period and subsequent arrhythmia development. </P><P><B><I>Methods and Results</I></B>—A total of 1,593 surgical procedures for congenital heart disease were performed. Dexmedetomidine was administered in the immediate post-operative period after 468 (29%) surgical procedures. Compared to 1,125 controls, the group receiving dexmedetomidine demonstrated significantly fewer tachyarrhythmias (29% vs. 38%, p<0.001), tachyarrhythmias receiving intervention (14% vs. 23%, p<0.001), bradyarrhythmias (18% vs. 22%, p=0.03) and bradyarrhythmias receiving intervention (12% vs. 16%, p=0.04). After propensity score matching with 468 controls, the arrhythmia incidence between groups became similar: tachyarrhythmias (29% vs. 31%, p=0.66), tachyarrhythmias receiving intervention (14% vs. 17%, p=0.16), bradyarrhythmias (18% vs. 15%, p=0.44) and bradyarrhythmias receiving intervention (12% vs. 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 [OR] 2.18, 95% confidence interval (CI) 1.02 - 4.65). Furthermore, there was a dose-dependent increase in the odds of bradyarrhythmias (OR 1.04, 95% CI 1.01 - 1.07) and bradyarrhythmias receiving intervention (OR 1.05, 95% CI 1.01 - 1.08). </P><P><B><I>Conclusions</I></B>—While dexmedetomidine exposure in the immediate post-operative 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.</P> 8 0 0 0 0 yes CircAE_CIRCAE-2014-002301-T.xml 002301_bullet points.docx CircAE_CIRCAE-2014-002301-T_file1.docx CircAE_CIRCAE-2014-002301-T_supp2.pdf CircAE_CIRCAE-2014-002301-T_supp3.pdf CircAE_CIRCAE-2014-002301-T_merge.pdf CircAE_CIRCAE-2014-002301-T_Fish_62217_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Fish_62217_copyright.pdf CircAE_CIRCAE-2014-002301-T_Radbill_62415_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Radbill_62415_copyright.pdf CircAE_CIRCAE-2014-002301-T_Xu_217578_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Xu_217578_copyright.pdf CircAE_CIRCAE-2014-002301-T_Smith_142512_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Smith_142512_copyright.pdf CircAE_CIRCAE-2014-002301-T_Shuplock_217571_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Shuplock_217571_copyright.pdf CircAE_CIRCAE-2014-002301-T_Marshall_236427_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Marshall_236427_copyright.pdf CircAE_CIRCAE-2014-002301-T_Van_Driest_139649_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Van_Driest_139649_copyright.pdf CircAE_CIRCAE-2014-002301-T_Saville_117714_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Saville_117714_copyright.pdf CircAE_CIRCAE-2014-002301-T_Owen_236573_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Owen_236573_copyright.pdf CircAE_CIRCAE-2014-002301-T_Kannankeril_38385_disclosure.pdf CircAE_CIRCAE-2014-002301-T_Kannankeril_38385_copyright.pdf Bill authors $70 per pg; no excess pgs. Article has supplemental material (1 PDF) and bullet points. No Figures Rec'd 5/28/14 (Invited from Circulation) Please set the flag 'exportcadmusahafundingtypecodes' with the funding type code of the sources you wish to list. Subject Codes: [41] Pediatric and congenital heart disease, including cardiovascular surgery [5] Arrhythmias, clinical electrophysiology, drugs ksine