Sefa GÜL, Osman Can YONTAR, Uğur ARSLAN, Mehmet Gültekin ERCAN, Oğuzhan TUĞRUL

Sağ Ventrikül Fonksiyonları Korunmuş Sekundum Atriyal Septal Defekti Olan Hastalarda Yeni Bir Atriyal Fibrilasyon Göstergesi Olarak P Dalgası Tepe Zamanının Değerlendirilmesi

Amaç: Sekundum atriyal septal defekti (ASD) olan hastalarda atriyal fibrilasyon (AF) gelişimini ön görmede p dalga dispersiyonu (PWDis), p dalga maksimum süresi (PWDmax), interatriyal blok (IAB), PR mesafesi gibi atriyal yeniden şekillenme ve elektriksel heterojeniteyi yansıtan bir çok elektrokardiyografik parametrenin faydalı olduğu bilinmektedir. Atriyal yeniden şekillenme ve elektriksel heterojeniteyi yansıtan yeni bir elektrokardiyografik parametre olan P dalga tepe süresi (PWPT)’nin ekokardiyografik olarak sağ kalp yetersizliği olmayan ASD hastalarında diğer p dalga göstergeleri ile korelasyon gösterip göstermediğini araştırdık. Materyal ve Metot: Çalışmaya ASD tanısı konmuş 46 hasta ve 50 sağlıklı erişkin dahil edildi. Tüm hastaların daha önce yapılmış olan transtorasik ekokardiyografileri (TTE) ve ASD si olanlara yapılmış olan transözefageal ekokardiyografi (TEE) raporları arşivden temin edildi. Çalışmaya TTE da sağ ventrikül fonksiyonları normal olmayan hastalar, ciddi kapak patolojisi olanlar ve ek konjenital kardiyak hastalığı olanlar dahil edilmedi. Ayrıca tüm hastalara elektrokardiyografi (EKG) çekildi ve kişisel bilgisayarlara aktarıldıktan sonra detaylı analizleri yapıldı. Bulgular: PWPTD2 ile ekokardiyografik ve elektrokardiyografik parametreler arasındaki korelasyonu değerlendirmek için yaptığımız Spearman’s korelasyon analizinde PWPTD2’nin PWDis ile (r=0,355, p<0,001), PR intervali ile (r=0,211, p<0,001) ve IAB ile (r=0,338, p=0,001) ile anlamlı korelasyon gösterdiğini tespit ettik. Ekokardiyografik parametreler ile PWPTD2 arasındaki korelasyon analizinde ise sağ atriyum alanı (RAA) (r=0,211, p=0,039) ve sağ atriyum en geniş çapı (RAD) ile (r=0,435, p<0,001) anlamlı korelasyon gösterdiğini tespit ettik (Tablo 5). Sonuç: Bu çalışma, PWPTD2’nin ASD hastalarında diğer atriyal repolarizasyon parametreleri ile anlamlı korelasyon gösterdiğini ispatlamıştır. Sonuç olarak; PWPTD2, sağ ventrikül fonksiyonlarının korunduğu ASD hastalarında AF gelişimini ön görmede bir belirleyici olarak kullanılabilir.

Anahtar Kelimeler:

atriyal septal defekt, P dalga tepe süresi, atriyal fibrilasyon

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