背景:右美托咪定和丙泊酚是重症监护病房和介入手术中常用的镇静剂。两者都可能损害窦房结功能和房室传导。这个前景的目标,随机研究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:在瑞士的三级护理中心,我们纳入了2019年9月至2020年10月的160例患者(65±11岁;32%为女性),通过冷冻球囊消融或射频消融进行首次消融治疗心房颤动。患者被随机分为右美托咪定(DEX组)与丙泊酚(PRO组)深度镇静。肺静脉隔离后,进行了标准的电生理研究,患者仍处于镇静状态且血液动力学稳定。
结果:80例患者随机分为DEX组和PRO组。DEX组患者的基线窦性周期长度较高(1022vs.1138ms;p=0.003)和更长的窦房结恢复时间(SNRT400;1597vs.1412ms;p=0.042)。然而,校正SNRT和标准化SNRT均无差异.DEX组患者的PR间期更长(207vs.186ms;p=0.002)和AH间隔(111与95ms,p=0.008),房室结的Wenckebach周期长度更长(512vs.456ms;p=0.005),和较长的房室结有效不应期(390vs.344ms;p=0.009)。QRS宽度和HV间隔没有差异。心律失常,主要是心房颤动,在电生理研究中诱导了33名患者,组间无差异(20%vs.15%,p=0.533)。
结论:右美托咪定对窦性心率和上房室传导的减缓作用比丙泊酚更明显,但不影响下房室传导和心室复极。在使用这些镇静剂时需要考虑这些差异。
背景:ClinicalTrials.gov编号NCT03844841,19/02/2019。
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.
BACKGROUND: ClinicalTrials.gov number NCT03844841, 19/02/2019.