Beta Bloker Tedavisi Almayan Kronik Koroner Arter Hastalarında Koroner Arter Bypass Cerrahisi Sonrasında Erken Dönemde Mevcut P Dalga Dispersiyonunun Atriyal Fibrilasyonu Öngörmedeki Rolü

Amaç: Koroner arter bypass cerrahisi (KABC) önerilmiş beta bloker (BB) kullanmayan stabil koroner arter hastalığı (KAH) olanlarda non-invaziv olarak değerlendirilebilen elektrokardiyografideki (EKG) en uzun P dalgası (Pmax), en kısa P dalgası (Pmin), P dalga dispersiyonu (PDD) gibi EKG parametrelerinin KABC sonrası gelişen atriyal fibrilasyon (AF) ile olan ilişkisini incelemek ve bu parametrelerin KABC sonrası gelişen AF' yi belirlemede bir öngördürücü olup olamayacağını değerlendirmektir.Gereç ve Yöntem: Kardiyoloji polikliniğine başvurarak stabil KAH' ı olan, kardiyak açıdan stabil, BB kullanımı ve aritmisi olmayan koroner anjyografi sonrası KABC önerilen yaşları 35-75 arası olan 100 hastadan oluşan bir grup çalışmaya alındı. Hastaların operayon öncesi çekilen EKG'lerine arşivdeki dosyalarından ulaşıldı ve 12 derivasyonun en az 9 tanesinde EKG parametrelerinin ölçülebilmesi şartı arandı. Bütün ölçümler manuel olarak büyüteç yardımıyla yapıldı. Hastalar KABC sonrası AF gelişen ve gelişmeyen olmak üzere iki gruba ayrıldı. Mevcut risk faktörleri, hemoglobin, hematokrit, kolesterol değerleri, açlık kan şekeri, HbA1c ekokardiyografik parametreler kaydedildi. Bulgular: Çalışmaya katılan hastaların yaşları 35 ile 75 arasında (ortalama 64.2±7.9) , çalışmaya katılanların 14'ü (%14) kadın, 86'sı (%86) erkekti. Katılımcıların 67'sinde (%67) hipertansiyon (HT), 46'sında (%46) diyabetes mellitus (DM), 40'ında (%40) hiperlipidemi (HL) tanıları bulunmaktaydı. BB kullanmayan ve bilinen aritmisi olmayan hastalarda dosyalarından ulaşılan operasyon öncesi EKG'lerinde bakılan Pmin ve Pmax değerlerinin arasındaki farkın operasyon sonrası AF gelişen hastalarda arttığı izlendi. Sonuç: Operasyon öncesi EKG'de bakılan P dalga dispersiyonunun artıkça operasyon sonrası erken dönemde AF gelişim riskini arttığı izlenmektedir

Undergoing Coronary Artery Bypass Surgery without Using B Bloker Medical Treatment

Role of P Wave Dispersion in the Prediction of Postoperative Atrial Fibrillation in the Early Period by Chronic Coronary Artery Patients Undergoing Coronary Artery Bypass Surgery without Using B Bloker Medical Treatment Objective: This study investigate that the relationships are between electrocardiographic (ECG) parameters such as maximum and minimum P wave value (Pmax, Pmin), P wave dispersion (PWD) ), that can be obtained in a noninvasive manner with post coronary arteria bypass graft surgery (CABGS) atrial fibrillation (AF) development and to evaluate whether these parameters can be used to estimate the development of AF in postoperative patients who aren’t using beta blockers and recommended to have CABGS. Material and Method:100 patients, that are between ages of 35-75, not using beta blockers, with stable coronary artery disease (CAD), without arythmia and recommended to have a CABGS after coronary angiography, are included in the study. The preoperative ECGs of the patients are obtained from patient files and the condition of ability to measure the electrocardiographic parameters in least 9 of the 12 leads is looked for. All the measurements are done manually with a looking glass. The patients are divided into two groups according to postoperative AF development. Present risk factors, haemoglobin, haematocrit, cholesterols, fasting blood glucose, HbA1c levels, echocardiographic parameters significantly are recorded. Results: Ages of the patients are between 35 and 75 (64.2±7.9), 14 are female (14%) and 86 are male (86%). 67 patients have hypertension (HT), 46 patients have diabetes mellitus (DM), 40 patients (40%) have hyperlipidemia (HL). The difference between Pmax and Pmin values that are obtained from preoperative ECGs of the patients are found to be greater in the patients that experienced postoperative AF. Conclusion: Increased preoperative PWD is shown to be associated with increased early postoperative AF development

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  • 1. Mallika V, Goswami B, Rajappa M. Atherosclerosis pathophysiology and the role of novel risk factors: a clinicobiochemical perspective. Angiology 2007; 58: 513-22.
  • 2. Grudy SM, Becker D, Clark LT, et al. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. National Cholesterol Education Program. National Heart Lung and Blood Institute. National Institutes of Health, NIH Publication September 2002; 2- 5215.
  • 3. Fuster V, Ryden LE, Cannom DS, et al. ACC/ AHA/ESC 2006 guidelines for management of patients with atrial fibrillation executive summary: a report of American Collage of Cardilogy/American Heart Association Task Force on Practice Guidelines and European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006; 48: 854-906.
  • 4. Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med 1995; 98: 476- 84.5. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (The Cardiovascular Health Study). Am J Cardiol 1994; 74: 236-41.
  • 6. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994; 271: 840-4.
  • 7. Dilaveris PE, Gialafos EJ, Sideris SK, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998; 135: 733-8.
  • 8. Rathore SS, Berger A, Weinfurt KP, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalance and outcomes. Circulation 2000; 101: 969-74.
  • 9. Moe GK, Abildskov JA. Atrial fibrillation as a self sustaining arrhythmia independent of focal discharge. Am Heart J 1959; 58: 59-70.
  • 10. Leier CV, Jewell GM, Magorien RD, Wepsic RA, Schaal SF. Interatrial conduction (activation) times. Am J Cardiol 1979; 44: 442-6.
  • 11. Raybaud F, Camous JP, Benoit P, Dolisi C, Baudouy M. Relationship between interatrial conduction times and left atrial dimention in patients undergoing atrioventricular stimulation. PACE 1995; 18: 447-50.
  • 12. Ceylan O, Bayata S, Yeşil M, Arıkan E, Postacı N. Value of interatrial conduction time and P wave dispersion in the prediction of atrial fibrillation following coronary bypass surgry. Anadolu Kardiyol Derg 2010; 10: 495-501.
  • 13. Hashemi Jazi M, Amirpour A, Zavvar R, Behjati M, Gharipour M. Predictive value of P-wave duration and dispersion in post coronary artery bypass surgery atrial fibrillation. ARYA Atheroscler 2012; 8: 59-62.
  • 14. Chandy J, Nakai T, Lee RJ, Bellows WH, Dzankic S, Leung JM. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg 2004; 98: 303-10.
  • 15. Ekim H, Kutay V, Demirbağ R, Turan E, Hazar A, Karadağ M. Koroner arter cerrahisi sonrası atrial fibrilasyon gelişiminde rol oynayan faktörler. Van Tıp Dergisi 2004; 11: 43-7.
  • 16. Haghjoo M, Basiri H, Salek M, et al. Predictors of postoperative atrial fibrillation after coronary artery bypass graft surgery. Indian Pacing Electrophysiol J 2008; 8: 94-101.
  • 17. Magee MJ, Herbert MA, Dewey TM, et al. Atrial fibrillation after coronary artery bypass grafting surgery: development of a predictive risk algorithm. Ann Thorac Surg 2007; 83: 1707-12.
  • 18. Yazici M, Ozdemir K, Altunkeser BB, et al. The effect of diabetes mellitus on the P-wave dispersion. Circ J 2007; 71: 880-3.
  • 19. Dogan A, Ozaydin M, Nazli C, et al. Does impaired left ventricular relaxation affect P wave dispersion in patients with hypertension? Ann Noninvasive Electrocardiol 2003; 8: 189-93.
  • 20. Dilaveris PE, Gialafos EJ, Chrissos D, et al. Detection of hypertensive patients at risk for paroxysmal atrial fibrillation during sinus rhythm by computerassisted P wave analysis. J Hypertens 1999; 17: 1463-70.
  • 21. Turhan H, Yetkin E, Sahin O, et al. Comparison of P-wave duration and dispersion in patients aged > or =65 years with those aged < or =45 years. J Electrocardiol 2003; 36: 321-6.