key: cord-0760442-fzo0tu5v
authors: Talib, Usama; Ahmad, Imama
title: DEXMDETOMIDINE-ASSOCIATED BRADYCARDIA: A BLESSING IN DISGUISE FOR MANAGEMENT OF ATRIAL TACHYARRYTHMIAS IN PATIENTS WITH COVID-19 REQUIRING SEDATION
date: 2020-10-31
journal: Chest
DOI: 10.1016/j.chest.2020.08.406
sha: 8c906707ae1575ca2fc0a8b7eb39f6328b8a9705
doc_id: 760442
cord_uid: fzo0tu5v

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USAMA TALIB AND IMAMA AHMAD INTRODUCTION: Dexmedetomidine is frequently used in ICU for sedation and for management of patients with alcohol withdrawal. Atrial tachyarrythmias including atrial fibrillation are frequently seen in ICU. We suggest use of dexmedetomidine for management of patients with atrial tachyarrythmias requiring sedation.

A 62-year old female with history of permanent atrial fibrillation (AF) was admitted to the ICU with acute hypoxic respiratory failure in the setting of COVID-19 infection requiring intubation. Labs on admission were notable for elevated ESR, CRP, LDH and fibrinogen with lymphopenia. COVID nasal swab was positive and CT chest on admission demonstrated diffuses bilateral infiltrates. The patient was noticed to be in AF with RVR on admission and was started on diltiazem drip. Versed was initially used for sedation with fentanyl for analgesia. AF with RVR was refractory to diltiazem drip, IV boluses of lopressor and diltiazem, esmolol infusion and digoxin load. A decision was made to change versed to dexmedetomidine for sedation to aid in control of AF with RVR. RVR was controlled within 1 hour of initiation of dexmedetomidine with heart rate improving from 140s to 80s. Patient was started on home diltiazem with AF remaining controlled after weaning of sedation and extubation.

DISCUSSION: Dexmedetomidine is used for sedation in the intensive care unit and is associated with hypotension and bradycadia as common side effects with very little risk of rebound hypertension associated with its discontinuation.

[1] Dexmedetomidine is also associated with a reduction in ICU stay, duration of mechanical ventilation and delirium as compared to other sedation alternatives.

[2] Arrhythmias are common with COVID-19 infection.

[3] Where bradycardia is a relatively known complication of dexmedetomidine, the use of dexmedetomidine for refractory atrial tachyrhythmias can be very effective in COVID-19 as well as non-COVID patients.

CONCLUSIONS: Dexmedetomidine can be effective in management of atrial tachyarrythmias owing to associated frequent bradyarrythmias. Dexmedetomidine must be considered as the sedation of choice for patients in ICU with refractory atrial fibrillation in COVID and non-COVID patients.

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