Murat Sucu, Gökhan Altunbaş, Ertan Vuruşkan, Fatma Yılmaz Coşkun

ST-segment elevasyonlu akut miyokard infarktüsü ile başvuran hastalarda interatrial ileti bozuklukları

Amaç: İnteratrial bloğun klinikte en önemli ilişkisi bu hastalarda atrial fibrilasyon ve iskemik strok riskinin arttığının gösterilmiş olmasıdır. Bu çalışmamızda ST-segment elevasyonlu akut miyokard infarktüsü (STEMI) ile başvurup primer perkütan koroner girişim (PCI) yapılan hastaların takibinde EKG’de P dalga süresi ve interatrial bloğu incelemeyi amaçladık. Gereç ve Yöntem: STEMI ile başvuran ve acil PCI uygulanan hastalar retrospektif olarak incelendi. Takip EKG’leri ve ekokardiyografileri sistemden tarandı. EKG ölçümleri SEMA Workstation 3.8.1 (Schiller AG) yardımıyla yapıldı. Bulgular: Primer analize 200 hasta dahil edildi. Ancak 20 hastanın hastane içi ölüm nedeniyle kaybedildiği ve 83 hastanın ise indeks olaydan sonra tekrar takibe gelmediği saptandı. Bu nedenle son analize 97 hasta (80 erkek, 17 kadın) dahil edildi. Ortalama yaş 57,0212,18 yıl idi. 48 hasta ön duvar STEMI ve 49 hasta ise alt duvar STEMI ile başvurdu. İndeks olay sonrası ortalama takip süresi 11 ay olarak hesaplandı.Takip süresi sonunda kısmi İAB %13,2, ileri İAB ise 7,7% olarak izlendi. İstatistiksel analiz sonucuna göre P dalga süresi ve İAB infarkt arter lokalizasyonu ile ilişkili bulunamadı. Aynı zamanda enfarktüs sonrası gelişen sol ventrikül sistolik disfonksiyonu ile de İAB arasında ilişkili bulunamadı. P dalga süresi ile sadece erkek cinsiyet ve sol atrial çap arasında anlamlı pozitif korelasyon izlendi. Sonuç: İAB’nin koroner arter hastalarında nadir olmadığı görüldü. Aynı zamanda enfarkt arterinin interatrial ileti ile ilişkisi olmadığı gözlendi.

Interatrial conduction disorders in patients with ST-elevation myocardial infarction

Aim: The most significant clinical association of interatrial block (IAB) was found with increased risk ofatrial fibrillation and ischemic stroke. In this study, we sought to evaluate P wave duration andinteratrial block in patients presented with acute ST-segment-elevation myocardial infarction (STEMI)who underwent primary percutaneous coronary intervention (PCI).Materials and Methods: We performed a retrospective analysis of patients presented with acuteSTEMI who underwent emergent PCI. Follow-up electrocardiograms were obtained from electronicdatabase system. Echocardiographic data were also obtained from electronic patient records.Electrocardiographic measurements were performed using SEMA Workstation 3.8.1 (Schiller AG).Results: Primary analysis included 200 consecutive patients with STEMI. However, there were 20 inhospital deaths and 83 patients were lost to follow-up. Remaining 97 patients (80 male, 17 female)were included in the final analysis. Mean age was 57.0212.18 years. There were 48 patients withanterior STEMI and 49 patients with inferior STEMI. Mean duration of follow-up was 11 months andECGs at the end of the follow up revealed that the frequency of partial and advanced IAB were 13.2%and 7.7% respectively. Statistical analysis showed that neither P wave duration nor IAB showedsignificant association with the infarct related artery lesion localization. Also, the degree of systolicdysfunction was not associated with IAB. Only male gender and left atrial diameter had significantpositive correlation with P wave duration.Conclusion: IAB was not rare in patients with a history of acute coronary syndrome. The infarctrelated artery does not seem to have a significant correlation with interatrial conduction.

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