Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery
Authors: Nagat S Elshmaa
Mohamed El-Kashlan
Wael El-Feky
Doaa Mohamed El Amrousy
Shimaa Elrifaey
Nahed Hablas
Samir Hassan
Mohamed Elsanosy
Journal: Journal of the American Heart Association (2017)
Discipline: CLINICAL MEDICINE
Keywords: children; dexmedetomidine; postoperative junctional ectopic tachycardia.
Affiliations: Pediatric Department, Tanta University Hospital, Tanta, Egypt ., Department of Anesthesia & Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt., Department of Anesthesia &amp; Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt, Pediatric Department, Tanta University Hospital, Tanta, Egypt., Cardiothoracic Surgery Department, Tanta University Hospital, Tanta, Egypt

Abstract:  Background: Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery. Methods and results: A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P&lt;0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P&lt;0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P&lt;0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P&gt;0.005). Conclusion: Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects. 

Retracted: No

PubPeer comments:
 Editorial Expression of Concern  The article  Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery, by El Amrousy et al, which published on March 1, 2017, and appeared in the March 15, 2017 issue of the journal, (J Am Heart Assoc. 2017;6:e004780. DOI: 10.1161 JAHA.116.004780) contains substantial overlap with a previously published article by Elu2010Shmaa et al, u201cThe efficacy of preu2011emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery,u201d which published online in Annals of Cardiac Anaesthesia on October 7, 2016 (Ann Card Anaesth. 2016 Octu2010Dec;19(4):614u2010620). Specifically, certain elements in the demographics and results presented in Tables 1u20103 in both articles appear to be nearly identical. These included the sex ratio and preoperative heart rate of the placebo control groups in Table 1 of each article; the intraoperative heart rate of the placebo control groups in Table 2 of each article; and the Vasoactive Inotropic Score, Ventilation Time, the Pediatric Cardiac Care Unit Length of Stay, the Hospital Length of Stay, and incidence of mortality bradycardia hypotension in Table 3 of each article. We are communicating with the authors involved in these publications. We are publishing this Expression of Concern while we await the outcome of these communications and to indicate that the data and statements in the listed publications may not be reliable. ,