Hipertansif olgularda nebivolol tedavisinin P dispersiyonu üzerine etkisi

maç: Hipertansiyon atriyal fibrilasyon (AF) gelişimini artıran önemli kardiyovasküler risk faktörlerindendir. Hipertansif hastaların atriyal iletisinde, elektriksel heterojenite ve instabilite olduğu gösterilmiştir. P dispersiyonu atriyal fibrilasyonun sensitif ve spesifik non-invaziv belirteci olabileceği gösterilmiştir. Nebivolol’ün P dispersiyonu üzerine etkisini inceleyen çalışma bildirilmemiştir. Çalışmamızın amacı nebivolol tedavisinin P dispersiyonu üzerine etkilerini irdelemek idi. Gereç ve Yöntem: Bu çalışmaya esansiyel hipertansiyon saptanan 65 hasta (yaş ortalaması 50.6±9.8; 31 erkek; 34 kadın) alındı. Çalışmaya katılan tüm hastaların biyokimyasal parametreleri, ekokardiyografileri ve EKG’de P dispersiyonu hesaplandı. Tüm olgulara nebivolol 5 mgr/gün başlandı. Altıncı ay sonunda biyokimyasal parametreler, EKO ve EKG tekrarlandı. Bulgular: Olguların EKG’lerinde belirlenen bazal ve tedavi sonrası P dispersiyonu 55.3±6’dan 33.5±7’e (p=0.000) gerilemiştir. Bu olumlu klinik düzelme sol ventrikül diyastolik fonksiyonundaki düzelme ve kan basıncındaki azalma ile kolere olup, sol atriyum çapı ile kolere değildi. Sonuç: Altı aylık nebivolol tedavisi belirgin olarak P dispersiyonu azaltıp atriyal aritmilere zemin hazırlayan atriyal miyokardı homojen hale getirmiştir.

Anahtar Kelimeler:

Elektrokardiyografi, Hipertansiyon

Effect of nebivolol treatment on P dispersion in hypertensive cases

Objectives: Hypertension is a important cardiovascular risk factors that promotes the development of atrial fibrillation (AF). Electrical heterogeneity and instability have been shown in the atrial conduction of hypertensive patients. P dispersion have been shown to be sensitive and specific noninvasive markers of atrial fibrillation. No study has been reported on the effect of Nebivolol on P dispersion. The objective of the present study is to Nebivolol treatment on the effect of P dispersion in hypertension of patient. Materials and Methods: The study included 65 patients (mean age 50.6±9.8; 31 males and 34 females) who were found to have essential hypertension. Biochemical parameters of all the patients in the study were analyzed, echocardiographies of all were taken and P dispersion was calculated in the ECG. All cases were put on 5 mg/day Nebivolol treatment. Biochemical parameter analyses, ECO and ECG were repeated in the 6th month. Results: Six-month Nebivolol treatment markedly reduced P dispersion and homogenized atrial myocardium, which provides a basis for atrial arrhythmias.

Keywords:

Electrocardiography, Hypertension,

PDF

___

1. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis and redisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N–9N.
2. Levy S. Factors predisposing to the development of atrial fibrillation. PACE 1997;20:2670–74.
3. Calhoun DA, Bakir S, Oparil S. Etiology and pathogenesis of essential hypertension. Crawford MH, DiMarco JP. Cardiokogy. Mosby 2001 London pp. 3 1.1-3 1.10.
4. Tukek T, Akkaya V, Demirel S, Sozen AB, Kudat H, Atilgan D, et al. Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 2000;85:896–99.
5. Aytemir K, Amasyali B, Abali G, Kose S, Kilic A, Onalan O, Tokgozoglu L, Kabakci G, Ozkutlu H, Nazli N, Isik E, Oto A. The signal-averaged P-wave duration is longer in hypertensive patients with history of paroxysmal atrial fibrillation as compared to those without. Int J Cardiol 2005;103(1):37–40.
6. Cha YM, Redfield MM, Shen WK, Gersh BJ. Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle.Circulation. 2004 Jun 15;109(23):2839-43.
7. Solti F, Vecsey T, Kekesi V, et al. The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovasc Res 1989;23:882–886.
8. Gersh BJ, Braunwald E, Bonow RO: Chronic coronary artery disease, in Braunwald E, Zipes DP, Libby P (eds): Heart Disease: A Textbook of Cardiovascular Medicine (ed 6). Philadelphia, PA, Saunders, 2001, p 1290.
9. Kawano S, Hiraoka M, Sawanobori T: Electrocardiographic features of p waves from patients with transient atrial fibrillation. Jpn Heart J 1988:29;57-67.
10. Dilaveris PE, Gialafos EJ, Sideris S, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733–38.
11. Devereux RB. Method of recognition and assesment of left ventricular hypertrophy. Medicographia 1995;17:12.
12. Devereux RB, De simone G, Schlussel CY. Echocardiographic left ventricular mass predicts risk of developing subseguent borderline hypertension. Am Coll Cardiol 1990;15:210-18.
13. Castellanos A, Kessler KM, Myerburg RJ. The resting electrocardiogram. In Alexander RW, Schlant RC, Fuster V. Hurst's The Heart, volume 1, USA, The McGraw-Hill Companies, 9 th edition, 1998; pp.371.
14. Brilla CG, Funck RC, Rupp H Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation. 2000 19;102(12):1388-93.
15. Mattioli AV, Bonatti S, Monopoli D, Zennaro M, Mattioli G Left atrial remodelling after short duration atrial fibrillation in hypertrophic hearts. Heart. 2005;91(1):91-92.
16. Yilmaz R, Demirbag R P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. Journal of Electrocardiology 2005:38;279–284.
17. Ozer N, Aytemir K, Ataler E, et al. P wave dispersion in hypertensive patients with paroxysmal AF. Pacing Clin Electrophysiol 2000;23:1859-1862.
18. Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunc K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
19. Turhan H, Yetkin E, Senen K, Yilmaz MB, Ileri M, Atak R, et al. Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis. Am J Cardiol 2002;89:607-09.
20. Turhan H, Yetkin E, Atak R, Altinok T, Senen K, Ileri M, et al. Increased P-wave duration and P-wave dispersion in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2003;8:18.
21. Senen K, Turhan H, Riza Erbay A, Basar N, Saatci Yasar A, Sahin O, et al. P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy. Eur J Heart Fail 2004;6:567-69.
22. Lammers WJ, Kirchhof C, Bonke FI, Allessie MA Vulnerability of rabbit atrium to reentry by hypoxia. Role of inhomogeneity in conduction and wavelength. Am J Physiol. 1992;262(1 Pt 2):H47-55.
23. Fareh S, Villemaire C, Nattel S. Importance of refractoriness heterogeneity in the enhanced vulnerability to atrial fibrillation induction caused by tachycardia-induced atrial electrical remodeling. Circulation 1998;98:2202-09.
24. Sugiura T, Iwasaka T, Takahashi N, Yuasa F, Takeuchi M, Hasegawa T, et al. Factors associated with atrial fibrillation in Q wave anterior myocardial infarction. Am Heart J 1991;121:1409-12.
25. Erbay AR, Turhan H, Yasar AS, Bicer A, Senen K, Sasmaz H, Sabah I, Yetkin E. Effects of long-term beta-blocker therapy on P-wave duration and dispersion in patients with rheumatic mitral stenosis. Int J Cardiol. 2005 Jun 22;102(1):33-37.
26. Dilaveris PE, Gialafos EJ, Andrikopoulos GK, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000;23:352–58.
27. Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ. Effects of autonomic stimulation and blockade on signal-averaged P wave duration. J Am Coll Cardiol 1995;26:497-5002.
28. Coumel P. Paroxysmal atrial fibrillation: a disorder of autonomic tone? Eur Heart J 1994;15(Suppl A):9.
29. Tukek T, Akkaya V, Atilgan D, Demirel E, Ozcan M, Guven O, Korkut F. Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation. Clin Cardiol. 2001 Oct;24(10):676-80.
30. Camsari A, Pekdemir H, Akkus MN, Yenihan S, Doven O, Cin VG. Long-term effects of beta blocker therapy on P-wave duration and dispersion in congestive heart failure patients: a new effect? J Electrocardiol. 2003 Apr;36(2):111-16.
31. Janssens WJ, Xhonneux R, Janssen PAJ. Animal pharmacology of Nebivolol. Drug Investşgation 3 (Suppl. 1):1991;13-24.
32. The sixt report of Jiont İnternational Committe on Prevention, Detection, Evaluation and treatment of high blood pressure; NIH Publication, November 1997.
33. Van Bartel LMAB, Breed JGS, Joosten J, Kragten A, Lusterning FATh, Moolj JMV. Nebivolol in hypertension: a double bind placebo controlled multicenter study assessing its antihypertansiveefficacy and impact on quality of life. J Cardiovasc Pharmacol 1993;2:856-62.
34. Nodari S, Metra M, Dei Cas L. Beta-blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol. Eur J Heart Fail 2003;5(5):621-27.
35. Fountoulaki K, Dimopoulos V, Giannakoulis J, Zintzaras E, Triposkiadis F. Left ventricular mass and mechanics in mild-tomoderate hypertension: effect of nebivolol versus telmisartan.Am J Hypertens 2005;18 (2 Pt 1):171-7.
36. Wit AL, Hoffmann BF, Rosen M. Electrophysiology and pharmacology of cardiac arrhythmias IX. Cardiac electrophysiologic effect of beta adrenergic receptor stimulation and blockade. Am Heart J 1975; 90:795–803.
37. Opie LH, Sonnenblick EH, Frishman W, Thadani U. Betablocking agents. In: Opie LH, editor. Drugs for the Heart, Fourth edition. Philadelphia7 WB Saunders; 1995. p. 1–30.