Ersin ÇELİK, Ömer TETİK, Orhan GÖKALP, Yüksel BEŞİR, Hasan İNER, Banu LAFÇI, Ali GÜRBÜZ, Ufuk YETKİN

Comparison of amiodarone and propafenone for maintenance ofstable sinus rhythm after bipolar radiofrequency ablation combined with a mitral valve procedure in patients with mitral valve disease andpersistent atrial fibrillation

Amaç: Bu çalışmada mitral kapak hastalığı ve uzun süreli atriyalfibrilasyonu olan hastalarda mitral kapak işlemi ile kombinebipolar radyofrekans ablasyon sonrasında stabil sinüs devamlılığınsağlanmasında amiodaron ve propafenonun etkileri karşılaştırıldı.Çalışmaplanı: Temmuz 2008 - Temmuz 2010 tarihleri arasındamitral kapak cerrahisi ile kombine bipolar radyofrekans ablasyonyapılan 75 hasta (29 erkek, 46 kadın; ort. yaş 66,8±7.4; dağılım 54-82yıl) çalışmaya dahil edildi. Hastalar 25er kişilik üç gruba ayrıldı:propafenon grubu (grup 1), amiodaron grubu (grup 2) ve kontrolgrubu (grup 3). Yavaş ventrikül yanıtlı atriyal fibrilasyonu olanhastalar çalışma dışı bırakıldı.Bul gu lar: Veriler ameliyat öncesi dönemde, ameliyat sırasında,taburculuk öncesinde ve taburculuk sonrası 3, 6. ve 18. aylarda toplandı.Tüm gruplardaki hastalar 18 ay izlendi. Grup 1de sinüs ritminde kalanhasta sayıları taburculuk anında, üç, altı ve 18. aylarda sırasıyla 22, 20,21 ve 21 idi. Grup 2de sinüs ritminde kalan hasta sayısı taburculukanında, üç, altı ve 18. aylarda sırasıyla 18, 13, 15 ve 16 idi. Grup 3tesinüs ritminde kalan hasta sayısı taburculuk anında, üç, altı ve 18.aylarda sırasıyla 16, 11, 12 ve 14 idi. Grup 1 istatistiksel olarak anlamlıderecede daha yüksek oranda stabil sinüs ritmine sahipti. Hiçbir gruptahastane mortalitesi görülmedi.Sonuç: Bu çalışma mitral kapak işlemi ile kombine bipolar radyofrekansablasyon yapılan hastalarda ameliyat sonrasındaki dönemde stabil sinüsritim devamlılığının sağlanmasında propafenonun amiodarona göredaha etkili olduğunu gösterdi.

Mitral kapak hastalığı v e uzun süreli atriyal fibrilasyonu o lan hastalarda mitral kapak işle mi ile kombine yapılan bipolar radyofre kans ablasyo n sonrasında stabil sinüs ritminin dev amlılığının sağlanmasında amiodaron ve pro pafeno nun karşılaştırılması

Background: This study aims to examine the effects of amiodaroneversus propafenone for maintenance of stable sinus rhythm after left atrialbipolar radiofrequency ablation combined with a mitral valve procedure inpatients with mitral valve disease and persistent atrial fibrillation.Methods: The study included 75 patients (29 males, 46 females; meanage 66,8±7.4 years; range 54 to 82 years) who underwent left atrialbipolar radiofrequency ablation combined with mitral valve surgerybetween July 2008 and July 2010. Patients were divided into three groupsof 25: propafenone group (group 1), amiodarone group (group 2), andcontrol group (group 3). Atrial fibrillation patients with slow ventricularresponse were excluded from the study.Results: Data was collected at preoperative period, during surgery, priorto discharge from hospital, and at 3, 6, and 18 months after discharge.Patients from all groups were followed for 18 months. In group 1, thenumber of patients in sinus rhythm was 22 at discharge, 20 at threemonths, and 21 at six and 18 months. In group 2, the number of patientsin sinus rhythm was 18 at discharge, 13 at three months, 15 at six months,and 16 at 18 months. In group 3, the number of patients in sinus rhythmwas 16 at discharge, 11 at three months, 12 at six months, and 14 at 18months. Group 1 had a statistically significantly higher rate of stablesinus rhythm. No hospital mortality was observed in any group.Conclusion: This study revealed that propafenone was more effectivethan amiodarone in maintenance of stable sinus rhythm at thepostoperative period in patients who underwent bipolar radiofrequencyablation combined with a mitral valve procedure.

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