右美托咪定与丙泊酚随机深度镇静的电生理差异

Electrophysiological differences of randomized deep sedation with dexmedetomidine versus propofol.

作者信息

Servatius Helge, Kueffer Thomas, Erdoes Gabor, Seiler Jens, Tanner Hildegard, Noti Fabian, Haeberlin Andreas, Madaffari Antonio, Branca Mattia, Dütschler Sophie, Theiler Lorenz, Reichlin Tobias, Roten Laurent

机构信息

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

出版信息

BMC Anesthesiol. 2024 Jul 31;24(1):263. doi: 10.1186/s12871-024-02647-x.

DOI:10.1186/s12871-024-02647-x

PMID:39085782

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11290000/

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.

摘要

背景

右美托咪定和丙泊酚是重症监护病房及介入手术中常用的镇静剂。两者均可能损害窦房结功能和房室传导。这项前瞻性随机研究的目的是比较右美托咪定与丙泊酚对窦房结功能和房室传导的影响。

方法

在瑞士的一家三级医疗中心，我们纳入了2019年9月至2020年10月期间160例（65±11岁；32%为女性）首次接受冷冻球囊消融或射频消融治疗房颤的患者。患者被随机分配至右美托咪定深度镇静组（DEX组）和丙泊酚组（PRO组）。在肺静脉隔离后，对仍处于深度镇静且血流动力学稳定的患者进行标准电生理研究。

结果

每组80例患者被随机分配至DEX组和PRO组。DEX组患者的基线窦房结周期长度更长（1022 vs. 1138 ms；p = 0.003），窦房结恢复时间更长（SNRT400；1597 vs. 1412 ms；p = 0.042）。然而，校正后的SNRT和标准化SNRT并无差异。DEX组患者的PR间期更长（207 vs. 186 ms；p = 0.002），AH间期更长（111 vs. 95 ms，p = 0.008），房室结文氏周期长度更长（512 vs. 456 ms；p = 0.005），房室结有效不应期更长（390 vs. 344 ms；p = 0.009）。QRS波宽度和HV间期无差异。在电生理研究期间，33例患者诱发了心律失常，主要为房颤，组间无差异（20% vs. 15%，p = 0.533）。