Valproik Asit Aritmiye Yol Açar mı?

Amaç : Antiepileptik olan sodyum valproat (valproik asit: VPA) ın anti aritmik bir etkiye de sahip olduğu düşünülmektedir. Bu çalışmanın amacı VPA"ın ektopik kardiak aritmi tedavisi üzerine etkisinin olup olamadığını araştırmaktır. Materyal-Metod: 1 Aralık 2009 ile 1 Haziran 2011 tarihlerini kapsayan çalışmamızda kriptojenik generalize tonik klonik nöbet tanısı almış 80 hasta prospektif bir çalışmayla gözlemlenmiştir. Bu çalışma Irak Sulaimaniya Genel Eğitim Hastenesinde yapılmıştır. Kırk hastaya VPA verilirken ve geri kalan 40 hastaya plasebo verildi. VPA uygulaması başlamadan 1 hafta öncesinden başlayarak ve 1 hafta sonrasına kadar tüm hastalar 24 saat boyunca kardiyak holter ile gözlemlenmiştir. Minumum kalp hızı oranı (MiHR) ve maksimum kalp hızı oranı (MxHR) ile total ektopik atrial aritmi sayıları (TNAE) değerlendirildi. Bulgular: VPA nın MiRH, MxRH ve TNAE yi önemli derecede azalttığı görülmüştür. Plasebo grubunda; MiHR grubundaki azalma istatistiksel olarak anlamlı iken MxRH ve TNAE gruplarındaki azalma anlamlı değildi. Ancak VPA ile tedavi edilen grupta görülen azalma doza bağımlı bir etki oluşturmamıştır. Terapiden 1 hafta öncesinde ve sonrasında yapılan değerlendirmede iki grup arasındaki MiHR azalma oranı istatistiksel olarak bir farklılık göstermemiştir. Sonuç: Sodyum valproat tedavisinin atrial ektopik atımlara etkili olduğu görülmektedir, dolayısıyla ektopik aritmi ve nöbet görülen hastalarda antiaritmitik olarak VPA"nın kullanılabileceği düşünülmektedir.

Anahtar Kelimeler:

Sodyum valproat, holter ile gözlem, atrial ektopi, nöbet.

Valproic acid: Does it have an antiarrhythmic action?

Objective: The antiepileptic sodium valproate (valproic acid; VPA) is thought to possess an antiarrhythmic action. We aimed to explore whether this medication influences cardiac atrial ectopics or not. Methods: From December 1, 2009 to June 1, 2011, 80 consecutive patients who were newly diagnosed with cryptogenic generalized tonic-clonic seizures were enrolled in this prospective short-term longitudinal observational study, which was conducted at the Sulaimaniya General Teaching Hospital, Iraq. Forty patients were allocated to receive VPA and the rest (n=40) were given placebo. All patients underwent cardiac 24-hour Holter monitoring before and after one week of VPA or placebo administration. The minimum heart rate (MiHR) and maximum heart rate (MxHR) as well as the total number of atrial ectopics (TNAE) were evaluated. Results: VPA significantly reduced the MiHR, MxHR, and the TNAE. In the placebo group, the reduction in the MiHR was statistically significant while the reduction in the MxHR and the TNAE were not. However, the reduction in the target parameters in the VPA-treated group did not demonstrate a dose-dependent effect. When both groups were evaluated head-to-head for the reduction in the MiHR before and after week of therapy, there was no statistically significant difference between them. Conclusion: Sodium valproate therapy appears to be effective against atrial ectopic beats and may be used as an antiarrhythmic medication in patients who co-experience seizures and troublesome atrial ectopics.

Keywords:

valproic acid; Holter monitoring; atrial ectopic; seizure,

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Yazışma Adresi / Address for Correspondence: Dr. Osama Shukir Muhammed Amin Sulaimaniya Post-Office, PO BOX 196, Sulaimaniya City, Iraq E-mail: dr.osama.amin@gmail.com. geliş tarihi/received :20.02.2013 kabul tarihi/accepted:25.03.2013