Effectiveness of Dexmedetomidine for Perioperative Ectopic Atrial Tachycardia in Infants with Congenital Heart Disease

Abstract

Background: Although Dexmedetomidine (DEX) is primarily classified as a sedative, several foreign studies have suggested that DEX is effective for perioperative atrial and junctional ectopic tachycardia．We report the efficacy of DEX for perioperative ectopic atrial tachycardia in two infants with congenital heart disease．
Case1: Patch closure of ventricular septal defects (VSDs) using the Sandwich method and pulmonary artery (PA) plasty were carried out in an 1-year-6 month old boy who previously underwent PA banding for multiple muscular VSDs．Ectopic atrial tachycardia (EAT) with a rate of 180 bpm was initiated followed by hypotension on post-operative day (POD) 22．Overdrive pacing, amiodarone, landiolol hydrochloride (LAN), a few sedatives, as well as a muscle relaxant agent were not effective for this EAT．We discontinued LAN following hypotension complicated by left ventricular (LV) dysfunction, while started DEX infusion of 0.7μg/kg/hr．After DEX administration, EAT was terminated without hypotension．
Case2: A 2-year-6-month old boy of Truncus arteriosus, who previously underwent PA resection and rt-m-Blalock-Taussig shunt, was operated using the Rastelli procedure and VSD patch closure．EAT about a rate of 190 bpm was initiated with hypotension, -on 1POD．Overdrive pacing, a sedative, and as a muscle relaxant agent were not effective for this EAT．We started DEX infusion of 0.6μg/kg/hr．After DEX administration, EAT was terminated successfully. None of the patients developed any adverse events, such as bradycardia and hypotension．
Conclusion: DEX appears to have novel antiarrhythmic properties for acute termination of EAT on perioperative infants associated with congenital heart disease．This report suggests that DEX may safely terminate EAT in cases complicated by LV dysfunction．