Muhammed KESKİN, Ahmet Taha ALPER, Ceyhan TÜRKKAN, Ahmet İlker TEKKEŞİN

Çok Sebepli Uzamış QT ve Basamaklı Bir Şekilde Başarılı Tedavisi

Uzamış QT (UQT), bir miyokardiyal repolarizasyon bozukluğu olup QT aralığının uzaması ve taşiaritmilerle karakterizedir. Bu durum; torsades depointes ventriküler taşikardisi (TdPVT), polimorfik ventriküler taşikardi (PVT) ve ventriküler fibrilasyona neden olabilir. Konjenital ve edinsel olmak üzere iki formu mevcuttur. Bu hastalığın edinsel formuna birçok ilaç veya elektrolit dengesizliği sebep olabilir. Edinsel ve konjenital formlarının akut dönemde tedavileri benzerdir. Biz olgu sunumumuzda tedaviye dirençli bir UQT hastasına yapılan; atriyal uyarma, lidokain ve meksiletin gibi güncel tedavi yöntemlerinin başarılı bir şekilde uygulanışını aktarmaya çalıştık.

Anahtar Kelimeler:

Uzamış QT, atriyal uyarma, meksiletin, amiodaron

Prolonged QT with Multiple-Causation and its Succesful Multistage Therapy

Prolonged QT (PQT) is a myocardial repolarization disorder characterized by a prolongation of the QT and a propensity to tachyarrhythmias, which may lead to torsades de pointes ventricular tachycardia (TdPVT), polymorphic ventricular tachycardia (PVT), and ventricular fibrillation. There are two forms of the disorder, including congenital and acquired PQT. There are many drugs and electrolyte disturbances that may lead to acquired form of PQT. Treatment of these two types of PQT at acute statement is similar. We report the current succesful therapies consisting of atrial pacing, lidocaine, and mexiletine for a PQT patient.

Keywords:

Prolonged QT, atrial pacing, mexiletine, amiodarone,

PDF

___

1. Schwartz PJ, Moss AJ, Vincent GM. Diagnostic criteria for the long QT syndrome: an update. Circulation 1993;88:782-4.
2. Jorens PG, Van Den Heuvel PA, Ranquin REF, Van Den Branden FA, Parizel GA. Amiodarone induced torsades de pointe: Report of three cases and review of literature. Acta Cardiol 1989;5:411-21.
3. Mattioni TA, Zheutlin TA, Sarmiento JJ, Parker M, Lesch M, Kehoe RF. Amiodarone in patients with previous drug-mediated torsade de pointes: Long-term safety and efficacy. Ann Intern Med 1989;111:574-80
4. Eldar M, Griffin JC, Abbott J, Benditt D, Bhandari A, Herre JM, et al. Permanent cardiac pacing in patients with the long QT syndrome. J Am Coll Cardiol 1987;10:600-7.
5. Rickards AF, Norman J. Relation between QT interval and heart rate. New design of physiologically adaptive cardiac pacemaker. Br Heart J 1981;45:56-61.
6. Yamada S, Kuga K, Yamaguchi I. Torsade de pointes induced by intravenous and long-term oral amiodarone therapy in a patient with dilated cardiomyopathy. Jpn Circ J 2001;65:236-8.
7. Park J, Kim SK, Pak HN. A case of Long QT syndrome type 3 aggravated by beta-blockers and alleviated by mexiletine: the role of epinephrine provocation test: Yonsei Med J 2013;54:529-33.