1. Electrophysiological differences of randomized deep sedation with dexmedetomidine versus propofol.
- Author
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Servatius, Helge, Kueffer, Thomas, Erdoes, Gabor, Seiler, Jens, Tanner, Hildegard, Noti, Fabian, Haeberlin, Andreas, Madaffari, Antonio, Branca, Mattia, Dütschler, Sophie, Theiler, Lorenz, Reichlin, Tobias, and Roten, Laurent
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ATRIAL fibrillation treatment , *PEARSON correlation (Statistics) , *PULMONARY veins , *T-test (Statistics) , *RESEARCH funding , *STATISTICAL sampling , *FISHER exact test , *RANDOMIZED controlled trials , *TERTIARY care , *RADIO frequency therapy , *HEMODYNAMICS , *DESCRIPTIVE statistics , *RESPIRATORY diseases , *MANN Whitney U Test , *PROPOFOL , *LONGITUDINAL method , *HEART conduction system , *ARRHYTHMIA , *ELECTROCARDIOGRAPHY , *ATRIAL fibrillation , *CONVALESCENCE , *SINOATRIAL node , *CATHETER ablation , *DATA analysis software , *ANESTHESIA , *IMIDAZOLES , *ATRIOVENTRICULAR node , *ELECTROPHYSIOLOGY , *TIME , *REGRESSION analysis - Abstract
Background: Dexmedetomidine and propofol are common sedatives in intensive care units and for interventional procedures. Both may compromise sinus node function and atrioventricular conduction. The objective of this prospective, randomized study is to compare the effect of dexmedetomidine with propofol on sinus node function and atrioventricular conduction. Methods: In a tertiary care center in Switzerland we included from September 2019 to October 2020 160 patients (65 ± 11 years old; 32% female) undergoing first ablation for atrial fibrillation by cryoballoon ablation or by radiofrequency ablation. Patients were randomly assigned to deep sedation with dexmedetomidine (DEX group) versus propofol (PRO group). A standard electrophysiological study was performed after pulmonary vein isolation with the patients still deeply sedated and hemodynamically stable. Results: Eighty patients each were randomized to the DEX and PRO group. DEX group patients had higher baseline sinus cycle length (1022 vs. 1138 ms; p = 0.003) and longer sinus node recovery time (SNRT400; 1597 vs. 1412 ms; p = 0.042). However, both corrected SNRT and normalized SNRT did not differ. DEX group patients had longer PR interval (207 vs. 186 ms; p = 0.002) and AH interval (111 vs. 95 ms, p = 0.008), longer Wenckebach cycle length of the atrioventricular node (512 vs. 456 ms; p = 0.005), and longer atrioventricular node effective refractory period (390 vs. 344 ms; p = 0.009). QRS width and HV interval were not different. An arrhythmia, mainly atrial fibrillation, was induced in 33 patients during the electrophysiological study, without differences among groups (20% vs. 15%, p = 0.533). Conclusions: Dexmedetomidine has a more pronounced slowing effect on sinus rate and suprahissian AV conduction than propofol, but not on infrahissian AV conduction and ventricular repolarization. These differences need to be taken into account when using these sedatives. Trial registration: ClinicalTrials.gov number NCT03844841, 19/02/2019 [ABSTRACT FROM AUTHOR]
- Published
- 2024
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