Mert Ilker HAYİROGLU, Duygu ILKE YİLDİRİM, Mehmet Ali ERYILMAZ

The effect of smoking cessation with or without bupropion on p wave duration and amplitude

Aim: In the current study, the impact of smoking cessation with and without bupropion usage on p wave duration and p waveamplitude in lead I has been analyzed. Bupropion, which is an atypical antidepressant with effects on both dopaminergic andnoradrenergic systems, is approved in the medical treatment of smoking cessation. Several cardiac side effects have been presentedwhen bupropion is prescribed in smoking cessation.Material and Methods: Our study has a prospective design which has planned to evaluate p wave amplitude in lead I and p waveduration changes of bupropion by comparing smoking patients (n=78) before and after bupropion usage. The patients prescribedbupropion were also compared to ex-smoker group (n=50) who quit smoking without bupropion usage in regard to p wave indicesin lead I. Differences in the median values between groups were analyzed using Mann-Whitney U test. Categorical variables wereanalyzed by chi-square test or Fisher’s exact test. For repeated measurements, paired sample t-test and Wilcoxon signed rank testswere used to evaluate the significance of the difference in parameters with normal and skewed distribution.Results: The study included both seventy-eight (79.5% male) patients under bupropion treatment and fifty (88.2% male) patientsstopped smoking without pharmacotherapy. P wave duration was notably higher when compared before and after smokingcessation with bupropion (99.0 ± 15.7 ms vs 96.2 ± 11.9ms; p120 mswas significantly higher in smoking patients. (p=0.014) The frequency of the patients with P wave duration

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1. Heeringa J, Kors JA, Hofman A, et al. Cigarette smoking and risk of atrial fibrillation: the Rotterdam Study. Am Heart J 2008;156:1163-9.
2. Tokgözoğlu L, Kayıkçıoğlu M, Altay S, et al. [EUROASPIREIV: European Society of Cardiology study of lifestyle, risk factors, and treatment approaches in patients with coronary artery disease: Data from Turkey]. Turk Kardiyol Dern Ars. 2017;45:134-44.
3. Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses–United States, 2002–2004. MMWR Morb Mortal Wkly Rep 2008;57:1226-8.
4. Hu Y, Zong G, Liu G, et al. Smoking cessation, weight change, type 2 diabetes, and mortality. N Engl J Med 2018;379:623- 32.
5. Culbertson CS, Bramen J, Cohen MS, et al. Effect of bupropion treatment on brain activation induced by cigarette-related cues in smokers. Arch Gen Psychiatry 2011;68:505-15.
6. Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokerswith and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet 2016;387:2507-20.
7. Cahill K, Stevens S, Perera R, et al. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013;5:CD009329.
8. Akturk E, Yağmur J, Açıkgöz N, et al. Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in smokers. J Interv Card Electrophysiol 2012;34:247-53.
9. Irfan A, Li Y, Bhatnagar A, et al. Association between serum cotinine levels and electrocardiographic left atrial abnormality. Ann Noninvasive Electrocardiol 2018:27:e12586.
10. Martínez-Sellés M, Baranchuk A, Elosua R, et al. Rationale and design of the BAYES (Interatrial Block and Yearly Events) registry. Clin Cardiol. 2017;40:196-9.
11. Alexander B, Haseeb S, van Rooy H, et al. Reduced P-wave voltage in lead I is associated with development of atrial fibrillation in patients with coronary artery disease. J Atr Fibrillation 2017;10:1657.
12. Park Jin-Kyu, Park Junbeom, Uhm Jae-Sun, et al. Low P-wave amplitude (<0.1 mV) in lead I is associated with displaced inter-atrial conduction and clinical recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation. Europace 2016;18:384-91.
13. Kizilirmak F, Demir GG, Gokdeniz T, et al. Changes in electrocardiographic P wave parameters after cryoballoon ablation and their association with atrial fibrillation recurrence. Ann Noninvasive Electrocardiol 2016;21:580-7.
14. Rigotti NA, Thorndike AN, Regan S, et al. Bupropion for smokers hospitalized with acute cardiovascular disease. Am J Med 2006;119:1080-7.
15. Tonstad S, Farsang C, Klaene G, et al. Bupropion SR for smoking cessation in smokers with cardiovascular disease: a multicentre, randomised study. Eur Heart J 2003;24:946- 55.
16. Mills EJ, Thorlund K, Eapen S, et al. Cardiovascular events associated with smoking cessation pharmacotherapies: a network meta-analysis. Circulation. 2014;129:28-41.
17. Druteika D, Zed PJ. Cardiotoxicity following bupropion overdose. Ann Pharmacother 2002;36:1791-5.
18. Taşolar H, Ballı M, Bayramoğlu A, et al. Effect of smoking on Tpe interval, Tpe/QT and Tpe/QTc ratios as indices of ventriculararrhythmogenesis. Heart Lung Circ.2014;23:827- 32.
19. Çinier G, Tekkeşin Aİ, Genç D, et al. Interatrial block as a predictor of atrial fibrillation in patients with ST-Segment elevation myocardial infarction. Clin Cardiol 2018;41:1232- 7.
20. Baranchuk A, Pang H, Seaborn GE, et al. Reverse atrial electrical remodelling induced by continuous positive airway pressure in patients with severe obstructive sleep apnoea. J Interv Card Electrophysiol 2013;36:247-53.
21. Özcan EE, Dural M, Görenek B. Tips for management of arrhythmias in endocrine disorders from an European Heart Rhythm Association position paper. Anatol J Cardiol 2018;20:241-5.