Dexmedetomidine sedation reduces the incidence of atrial fibrillation in mechanically ventilated patients with COVID-19 pneumonia: A randomized controlled trial

Abstract

ABSTRACTBackground Atrial fibrillation (AF) is a cardiac complication commonly associated with COVID-19 infection, especially in severe cases. The sedative agent dexmedetomidine is known to cause bradycardia. In this study, we are testing whether dexmedetomidine could reduce the occurrence of AF in mechanically ventilated COVID-19 patients.Methods This prospective trial included 144 patients who were randomly allocated to one of two groups: Group C patients were sedated with propofol and fentanyl. Group D patients were sedated with the same medications in addition to dexmedetomidine infusion.Results Demographic, clinical, and cardiac characteristics of all patients did not significantly differ between the two groups. The duration of intensive care unit (ICU) stay was comparable between the two groups. However, both propofol and fentanyl consumption significantly declined in Group D. The number of AF attacks showed a significant decline in association with dexmedetomidine administration (mean = 12.5% in Group D vs. 29.2% in Group C). Dexmedetomidine also reduced the amount of required electrical cardioversion episodes. Additionally, antiarrhythmic medication needed reduced significantly in Group D. Mortality rates did not differ between the two study groups (58.3% and 63.8% in Groups D and C, respectively).Conclusions Dexmedetomidine is associated with a significant reduction in the burden of AF in patients with severe COVID-19 infection, manifested by fewer AF attacks, the need for electrical cardioversion shocks, and the consumption of antiarrhythmic medication without impact on mortality.

Keywords

• Covid-19
• atrial fibrillation
• dexmedetomidine
• sedation