Suat CANBAZ, Ümit HALICI, Enver DURAN, Ebru YAVUZ, Turan EGE, Kemal BALCI, Nilda TURGUT

Evaluation of R-R interval variability with electromyography following coronary artery bypass grafting

Amaç: R-R interval değişkenliği (RRİD) analizi kalbin otonomik fonksiyonu hakkında bilgi verir. Koroner arter bypass cerrahisi sonrasında RRİD belirgin olarak azalmaktadır. Çalışmamızda, koroner arter bypass cerrahisi uygulanan hastalarda alternatif bir yöntem olarak elektromiyografi (EMG) ile RRİD değerlendirildi. Çalışma planı: Çalışmaya koroner arter bypass cerrahisi yapılan 19 hasta (6 kadın, 13 erkek; ort. yaş 57.8±10.2) alındı. Tüm hastalarda istirahat ve hiperventilasyon sırasında olmak üzere, ameliyat öncesinde ve ameliyattan bir ve iki ay sonrasında EMG ile RRİD analizi yapıldı. Bulgular: Ameliyat öncesiyle karşılaştırıldığında, ameliyattan bir ay (R-R, istirahat, p=0.001; R-R, hiperventilasyon, p=0.009) ve iki ay (R-R, istirahat, p=0.001; R-R, hiperventilasyon, p=0.006) sonra istirahat ve hiperventilasyon sırasında elde edilen ortalama RRİD değerleri anlamlı derecede düşük bulundu. Ameliyattan bir ay sonraki ortalama RRİD değerleri, ikinci ay sonundaki değerlerden anlamlı derecede düşük idi (R-R, istirahat, p=0.01; R-R, hiperventilasyon, p=0.001). R-R interval değişkenliği ile yaş, cinsiyet, hipertansiyon, sigara içme, total kolesterol ve trigliserid düzeyleri, beden kütle indeksi; cerrahi, kardiyopulmoner bypass, kros klemp, mekanik ventilasyon ve yoğun bakımda kalma süreleri arasında ilişki görülmedi. Sonuç: Bulgularımız, koroner arter bypass ameliyatından sonraki ilk iki ayda RRİD değerlerinin anlamlı derecede düştüğünü, ikinci aydaki değerlerde kısmi düzelme meydana geldiğini gösterdi. R-R interval değişkenliğinin EMG ile analizi, koroner arter bypass ameliyatı uygulanan hastalarda zaman kaybına yol açmayan, EMG laboratuvarında kolaylıkla yapılabilen ve kalbin otonomik fonksiyonunu yansıtan bir seçenektir.

Koroner arter bypass cerrahisi sonrasında R-R interyal değişkenliğinin elektromiyografı ile değerlendirilmesi

Background: Analysis of R-R interval variability (RRIV) provides information about cardiac autonomic function. Coronary artery bypass grafting (CABG) causes marked attenuation of RRIV. We analyzed RRIV with an alternative method using electromyography (EMG) in patients undergoing CABG. Methods: The study included 19 consecutive patients (6 females, 13 males; mean age 57.8±10.2 years) undergoing CABG. R-R interval variability was assessed by EMG studies during quiet and deep breathing before, and one and two months after surgery. Results: Compared to preoperative values, the mean RRIV values were significantly lower during quiet and deep breathing after one (R-R, quiet, p=0.001; R-R, deep, p=0.009) and two (R-R, quiet, p=0.001; R-R, deep, p=0.006) months of CABG. The mean RRIV values one month after surgery were significantly lower than those obtained two months postoperatively (R-R, quiet, p=0.01; R-R, deep, p=0.001). No correlations were found between RRIV and the following: age, gender, hypertension, smoking, total cholesterol, triglyceride, body mass index, duration of surgery, duration of cardiopulmonary bypass, cross clamp time, mechanical ventilation time, and intensive care unit stay. Conclusion: Our data showed that CABG is associated with significant attenuation of RRIV within the first two postoperative months, with partial improvement in the latter. Analysis of RRIV with the use of EMG is an alternative method in patients undergoing CABG. It is not a timeconsuming procedure, is easily performed in the EMG laboratory, and is a simple way of reflecting the autonomic function of the heart.

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