Dexmedetomidine may reduce new-onset atrial fibrillation in ICU patients: JAMA

South Korea: A new study published in JAMA Network Open suggests that the use of dexmedetomidine, a sedative commonly used in intensive care units (ICUs), may be associated with a reduced risk of new-onset atrial fibrillation (NOAF) in critically ill patients.

NOAF is a common complication in critically ill patients and is associated with increased morbidity and mortality. The purpose of the study is to determine if the use of dexmedetomidine relates to the occurrence of NOAF in critically ill patients.

The study used a propensity score-matched cohort design and analyzed 22,237 patients’ data from the Medical Information Mart for Intensive Care-IV database from 2008-2019.

Patients were divided into two groups based on dexmedetomidine exposure, those who got dexmedetomidine within 48 hours of ICU admission (dexmedetomidine group) and those who did not (no dexmedetomidine group). Outcomes such as NOAF occurrence, ICU/hospital length of stay, and in-hospital mortality were recorded.

The study revealed the following clinical takeaways:

1. After matching, the cohort included 8015 patients, among whom 2106 received dexmedetomidine and 5909 did not.

2. The use of dexmedetomidine was associated with a decreased risk of NOAF.

3. Patients in the dexmedetomidine group had longer ICU and hospital lengths of stay, but dexmedetomidine was associated with a decreased risk of in-hospital mortality.

The study's lead author, Dr. Myung Jin Song, notes that “The use of dexmedetomidine may provide a new avenue for preventing NOAF in ICU patients. It may be necessary to evaluate the association between dexmedetomidine and NOAF in future clinical trials.”

The study suggests that the use of dexmedetomidine may be a viable option for preventing NOAF in critically ill patients. As always, decisions regarding sedation and treatment should be made on a case-by-case basis, considering the patient's individual medical history and current condition.

Reference:

Song MJ, Jang Y, Lee JH, et al. Association of Dexmedetomidine with New-Onset Atrial Fibrillation in Patients With Critical Illness. JAMA Netw Open. 2023;6(4):e239955. doi:10.1001/jamanetworkopen.2023.9955